CMS/EIP Fiscal Report Center: 09
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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 17 24.500000 1663.8000 67.9102
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 12.500000 842.5000 67.4000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 12 18.000000 1260.3700 70.0206
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 18 31.000000 1637.2500 52.8145
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 16 23.500000 1637.8700 69.6966
Subtotal (Total Children Is Unduplicated) 43 109.500000 7041.7900 64.3086
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Total 109.500000 7041.7900 64.3086
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Number of Children (Unduplicated) With at Least One Service 43
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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 23 34.500000 2000.1700 2000.1700
D 0 0.000000 0.0000 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
40 64.000000 4216.6200 0.0000
Other 8 11.000000 825.0000 0.0000
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Total 71 109.500000 7041.7900 2000.1700