CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2019 ending 12/31/2019 Date of Report:02/01/2020 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 14 20.500000 1477.5000 72.0732
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 10 15.500000 860.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 20.500000 1537.5000 75.0000
Subtotal (Total Children Is Unduplicated) 22 56.500000 3875.2500 68.5885
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Total 56.500000 3875.2500 68.5885
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Number of Children (Unduplicated) With at Least One Service 22
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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 16 25.500000 1667.2500 1667.2500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 12 17.000000 1187.2500 0.0000
T 1 1.500000 112.5000 112.5000
6 8.000000 570.7500 0.0000
Other 4 4.500000 337.5000 0.0000
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Total 39 56.500000 3875.2500 1779.7500