CMS/EIP Fiscal Report Center: 09
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
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 11 15.500000 1162.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 10 13.500000 828.7500 61.3889
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 16.500000 1170.0200 70.9103
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 23 37.000000 1955.5000 52.8514
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 5.500000 330.5200 60.0945
Subtotal (Total Children Is Unduplicated) 38 95.000000 5933.2900 62.4557
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Total 95.000000 5933.2900 62.4557
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Number of Children (Unduplicated) With at Least One Service 38
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Center 09
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 45 68.500000 4218.0400 4218.0400
D 1 2.000000 111.0000 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
10 15.000000 921.0000 0.0000
Other 6 9.500000 683.2500 0.0000
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Total 62 95.000000 5933.2900 4218.0400