CMS/EIP Fiscal Report              Center: 06 
Services beginning 10/01/2019 ending 12/31/2019                Date of Report:02/01/2020   Page:   1
            List order: No List
    Agency Filter:EIP DEI DEIP     
    Payclass Filters:TPIN    
    Eligibility Filter:Part C (excluding not eligible)
 
 
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               1.500000          112.5000           75.0000
  IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT             1               2.000000          150.0000           75.0000
  IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT             1               2.000000          150.0000           75.0000
  IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS             1               1.500000           83.2500           55.5000
  IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT      32              48.000000         3600.0000           75.0000
  IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT        23              35.500000         2662.5000           75.0000
  IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT        38              62.500000         4687.5000           75.0000
  IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS      89             135.000000         7492.5000           55.5000
  IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF     59              91.000000         6825.0000           75.0000
Subtotal (Total Children Is Unduplicated)                125             379.000000        25763.2500           67.9769
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Total                                                                    379.000000        25763.2500           67.9769
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Number of Children (Unduplicated) With at Least One Service        125
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Center 06
Flag      Claims          Units         Chgs         Paid
---------------------------------------------------------
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              0       0.000000       0.0000       0.0000 
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 
             247     379.000000   25763.2500       0.0000 
Other          0       0.000000       0.0000       0.0000 
---------------------------------------------------------
Total        247     379.000000   25763.2500       0.0000