CMS/EIP Fiscal Report Center: 01
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.00 375.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.00 150.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.50 112.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 4.50 249.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 45 62.00 4650.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 7.50 562.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 10.50 787.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 37 49.50 2747.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 19 27.00 1987.50 73.61
Subtotal (Total Children Is Unduplicated) 60 169.50 11622.00 68.57
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EI Services,Class #03
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 10.75 800.87 74.50
Subtotal (Total Children Is Unduplicated) 1 10.75 800.87 74.50
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Total 180.25 12422.87 68.92
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Number of Children (Unduplicated) With at Least One Service 61
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Center 01
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 45 60.00 3495.75 0.00
S 2 3.00 225.00 0.00
H 3 4.50 337.50 0.00
T 0 0.00 0.00 0.00
7 4.75 393.59 0.00
Other 77 108.00 7971.03 0.00
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Total 134 180.25 12422.87 0.00