CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Payclass Filters:TPIN
Eligibility Filter:Not Part C
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 3 4.98 614.32 123.36
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.50 266.14 177.43
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.09 82.05 75.28
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 5.50 798.42 145.17
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 5.09 614.33 120.69
Subtotal (Total Children Is Unduplicated) 4 18.16 2375.26 130.80
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Total 18.16 2375.26 130.80
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Number of Children (Unduplicated) With at Least One Service 4
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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 3 3.66 246.14 246.14
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
8 14.50 2129.12 0.00
Other 0 0.00 0.00 0.00
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Total 11 18.16 2375.26 246.14