CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2018 ending 12/31/2018 Date of Report:02/06/2019 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 64.6700 32.3350
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 10 15.500000 994.6500 64.1710
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 18 27.000000 1498.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 14 23.000000 1650.0000 71.7391
Subtotal (Total Children Is Unduplicated) 27 71.500000 4429.8200 61.9555
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Total 71.500000 4429.8200 61.9555
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Number of Children (Unduplicated) With at Least One Service 27
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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 26 41.000000 2488.6700 2488.6700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 6 8.000000 600.0000 0.0000
T 3 6.000000 318.1500 318.1500
8 11.000000 678.7500 0.0000
Other 4 5.500000 344.2500 0.0000
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Total 47 71.500000 4429.8200 2806.8200