CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2018 ending 03/31/2018 Date of Report:05/05/2018 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 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.500000 194.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 22 29.000000 2090.0000 72.0690
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 4.500000 302.5000 67.2222
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 15 22.000000 1650.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 15 26.000000 1373.0000 52.8077
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 25 35.500000 2501.5000 70.4648
Subtotal (Total Children Is Unduplicated) 50 128.000000 8673.7500 67.7637
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Total 128.000000 8673.7500 67.7637
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Number of Children (Unduplicated) With at Least One Service 50
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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 48 73.500000 4733.7500 4733.7500
D 1 1.500000 112.5000 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
9 13.500000 865.0000 0.0000
Other 28 39.500000 2962.5000 0.0000
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Total 86 128.000000 8673.7500 4733.7500