CMS/EIP Fiscal Report Center: 52
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 2.50 187.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 2.50 138.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 31 51.50 3862.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 10.00 750.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 52 85.50 4745.25 55.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 2 2.00 100.00 50.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 3 3.00 145.50 48.50
Subtotal (Total Children Is Unduplicated) 64 158.00 9978.00 63.15
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 12.00 300.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 44.75 2237.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 31 135.50 6775.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 7 53.00 3597.64 67.88
PHY-97110-PT SESSION BY LICENSED PT 8 24.75 1680.03 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 19 87.47 5937.59 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1 24.00 12.00 0.50
Subtotal (Total Children Is Unduplicated) 66 381.47 20539.76 53.84
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Total 539.47 30517.76 56.57
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Number of Children (Unduplicated) With at Least One Service 119
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Center 52
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 1 0.72 49.00 49.00
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 17 52.75 2902.17 0.00
T 0 0.00 0.00 0.00
231 486.00 27566.59 0.00
Other 0 0.00 0.00 0.00
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Total 249 539.47 30517.76 49.00