CMS/EIP Fiscal Report Center: 52
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 Page: 1
Agency Filter:EXT
Payclass Filters:LEA
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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.50 50.00 33.33
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 2 3.00 100.00 33.33
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 17 25.50 912.50 35.78
Subtotal (Total Children Is Unduplicated) 20 30.00 1062.50 35.42
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EI Services,Class #03
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 48 243.00 7290.00 30.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 42.00 1260.00 30.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1 4000.00 30.00 0.01
Subtotal (Total Children Is Unduplicated) 52 4285.00 8580.00 2.00
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Total 4315.00 9642.50 2.23
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Number of Children (Unduplicated) With at Least One Service 72
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Center 52
Flag Claims Units Chgs Paid
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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
129 4315.00 9642.50 0.00
Other 0 0.00 0.00 0.00
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Total 129 4315.00 9642.50 0.00