CMS/EIP Fiscal Report Center: 53
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
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 1 2.00 111.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.00 266.14 133.07
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 8.00 948.42 118.55
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 16.00 1663.70 103.98
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 14.00 1514.56 108.18
Subtotal (Total Children Is Unduplicated) 8 42.00 4503.82 107.23
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 2.00 100.00 50.00
Subtotal (Total Children Is Unduplicated) 1 2.00 100.00 50.00
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Total 44.00 4603.82 104.63
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Number of Children (Unduplicated) With at Least One Service 9
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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 0 0.00 0.00 0.00
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
23 44.00 4603.82 0.00
Other 0 0.00 0.00 0.00
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Total 23 44.00 4603.82 0.00