CMS/EIP Fiscal Report Center: 04
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 0.500000 525.6000 1051.2000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 20 22.000000 3258.5600 148.1164
Subtotal (Total Children Is Unduplicated) 21 22.500000 3784.1600 168.1849
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Total 22.500000 3784.1600 168.1849
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Number of Children (Unduplicated) With at Least One Service 21
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Center 04
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 14 14.000000 3146.6600 3146.6600
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
10 8.500000 637.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 24 22.500000 3784.1600 3146.6600