CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2009 ending 09/30/2009 Date of Report:11/17/2009 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
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 2 1.09 52.99 48.61
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 8 14.65 813.34 55.52
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 7 11.64 873.27 75.02
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 5.27 394.90 74.93
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 13 21.82 1211.06 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.04 227.93 74.98
Subtotal (Total Children Is Unduplicated) 17 57.51 3573.49 62.14
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 12.00 600.00 50.00
Subtotal (Total Children Is Unduplicated) 3 12.00 600.00 50.00
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Total 69.51 4173.49 60.04
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Number of Children (Unduplicated) With at Least One Service 20
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Center 53
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 19 21.51 1341.49 1342.32
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
30 48.00 2832.00 0.00
Other 0 0.00 0.00 0.00
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Total 49 69.51 4173.49 1342.32