CMS/EIP Fiscal Report Center: 52
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-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 26 59.000000 3776.9000 64.0153
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 10.000000 750.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 6.500000 387.5000 59.6154
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 30 58.000000 3181.2500 54.8491
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
Subtotal (Total Children Is Unduplicated) 35 143.500000 8767.6500 61.0986
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Total 143.500000 8767.6500 61.0986
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Number of Children (Unduplicated) With at Least One Service 35
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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 7 12.500000 862.0000 505.4900
D 4 7.500000 416.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 26 49.500000 3225.0000 0.0000
T 20 37.500000 2075.6100 1942.8600
19 36.500000 2188.7900 150.0000
Other 0 0.000000 0.0000 0.0000
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Total 76 143.500000 8767.6500 2598.3500