CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2020 ending 03/31/2020 Date of Report:05/15/2020 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
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 4.000000 300.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 11 17.000000 1275.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 2.500000 187.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 15 24.000000 1332.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 17.500000 1312.5000 75.0000
Subtotal (Total Children Is Unduplicated) 23 65.000000 4407.0000 67.8000
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Total 65.000000 4407.0000 67.8000
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Number of Children (Unduplicated) With at Least One Service 23
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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 15 24.000000 1575.7500 1575.7500
D 1 1.000000 55.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 16 24.500000 1642.5000 0.0000
T 0 0.000000 0.0000 0.0000
6 9.000000 675.0000 0.0000
Other 4 6.500000 458.2500 0.0000
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Total 42 65.000000 4407.0000 1575.7500