CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 Page: 1
Agency Filter:EIP DEI DEIP
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
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 8 8.00 444.00 55.50
Subtotal (Total Children Is Unduplicated) 8 8.00 444.00 55.50
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EI Services,Class #03
ECE-ECE-EARLY CHILDHOOD EDUCATION 3 124.00 1116.00 9.00
OCCT-97530-OT SESSION BY LICENSED OT 2 3.50 237.58 67.88
PHY-97110-PT SESSION BY LICENSED PT 2 3.00 203.64 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 6.50 441.22 67.88
Subtotal (Total Children Is Unduplicated) 7 137.00 1998.44 14.59
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Total 145.00 2442.44 16.84
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Number of Children (Unduplicated) With at Least One Service 15
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Center 06
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
4 2.00 135.76 0.00
Other 0 0.00 0.00 0.00
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Total 4 2.00 135.76 0.00
Center 09
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
12 17.00 1054.92 0.00
Other 0 0.00 0.00 0.00
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Total 12 17.00 1054.92 0.00
Center 57
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
6 145.00 2442.44 0.00
Other 0 0.00 0.00 0.00
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Total 6 145.00 2442.44 0.00