CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 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
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 21 35.26 5209.66 147.75
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 11.00 1596.84 145.17
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 4.55 494.54 108.69
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 6.00 566.14 94.36
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 26 42.92 6155.48 143.42
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 18 35.49 5243.06 147.73
Subtotal (Total Children Is Unduplicated) 31 135.22 19265.72 142.48
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 4.00 200.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 4 13.37 3043.28 227.62
Subtotal (Total Children Is Unduplicated) 5 17.37 3243.28 186.72
----------------------------------------------------------------------------------------------------------------
Total 152.59 22509.00 147.51
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 35
----------------------------------------------------------------------------------------------------------------
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
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 7 4.09 260.40 260.40
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
92 148.50 22248.60 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 99 152.59 22509.00 260.40