CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2017 ending 12/31/2017 Date of Report:02/03/2018 Page: 1
List order: No List
Payclass Filters:TPIN
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 8 12.500000 937.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 9.500000 712.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 15.500000 860.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 4.000000 300.0000 75.0000
Subtotal (Total Children Is Unduplicated) 18 41.500000 2810.2500 67.7169
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EI Services,Class #03
INTR-T1013-INTERPRETER 1 0.250000 12.5000 50.0000
Subtotal (Total Children Is Unduplicated) 1 0.250000 12.5000 50.0000
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Total 41.750000 2822.7500 67.6108
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Number of Children (Unduplicated) With at Least One Service 19
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Center 01
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 3 5.500000 305.2500 305.2500
D 2 1.250000 87.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 4 6.000000 450.0000 0.0000
T 0 0.000000 0.0000 0.0000
15 23.000000 1559.2500 0.0000
Other 4 6.000000 420.7500 0.0000
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Total 28 41.750000 2822.7500 305.2500