CMS/EIP Fiscal Report Center: 52
Services beginning 10/01/2011 ending 12/31/2011 Date of Report:02/16/2012 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:LEA
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 5 10.000000 372.0000 37.2000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 14 24.000000 838.5000 34.9375
Subtotal (Total Children Is Unduplicated) 19 34.000000 1210.5000 35.6029
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EI Services,Class #03
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 9 83.500000 4175.0000 50.0000
Subtotal (Total Children Is Unduplicated) 9 83.500000 4175.0000 50.0000
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Total 117.500000 5385.5000 45.8340
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Number of Children (Unduplicated) With at Least One Service 28
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Center 52
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
44 117.500000 5385.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 44 117.500000 5385.5000 0.0000