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:EIP DEI DEIP
Payclass Filters:OTHER
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
EXIT-EXIT-TRANSITION ASSESSMENT 2 1.25 62.50 50.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 0.50 37.50 75.00
Subtotal (Total Children Is Unduplicated) 3 1.75 100.00 57.14
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 3.00 1430.00 476.67
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 0.50 25.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 4 10.25 695.77 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 1.25 84.85 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 4 59.00 29.50 0.50
Subtotal (Total Children Is Unduplicated) 10 74.00 2265.12 30.61
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Total 75.75 2365.12 31.22
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Number of Children (Unduplicated) With at Least One Service 13
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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 3 9.75 661.83 0.00
T 0 0.00 0.00 0.00
13 66.00 1703.29 0.00
Other 0 0.00 0.00 0.00
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Total 16 75.75 2365.12 0.00