CMS/EIP Fiscal Report Center: 52
Services beginning 07/01/2019 ending 09/30/2019 Date of Report:11/04/2019 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 19 43.500000 2880.0000 66.2069
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 12 30.000000 2065.6500 68.8550
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 7.500000 562.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 25 47.500000 2636.2500 55.5000
Subtotal (Total Children Is Unduplicated) 26 128.500000 8144.4000 63.3805
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Total 128.500000 8144.4000 63.3805
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Number of Children (Unduplicated) With at Least One Service 26
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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 9 17.000000 1206.7500 651.8100
D 1 2.000000 150.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 16 29.500000 2085.7500 0.0000
T 23 44.000000 2471.9200 2341.9200
18 36.000000 2229.9800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 67 128.500000 8144.4000 2993.7300