CMS/EIP Fiscal Report Center: 51
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 Page: 1
Agency Filter:EIP DEI DEIP
Payclass Filters:TPIN
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.00 75.00 75.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 2 2.00 123.50 61.75
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 5.00 339.40 67.88
Subtotal (Total Children Is Unduplicated) 1 5.00 339.40 67.88
----------------------------------------------------------------------------------------------------------------
Total 7.00 462.90 66.13
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 3
----------------------------------------------------------------------------------------------------------------
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 0 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
7 7.00 462.90 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 7 7.00 462.90 0.00