CMS/EIP Fiscal Report Center: 52
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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 18 38.500000 2652.5000 68.8961
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 22.000000 1427.7200 64.8964
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 14.500000 1030.6500 71.0793
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 21 40.500000 2247.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
Subtotal (Total Children Is Unduplicated) 21 117.000000 7471.1200 63.8557
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Total 117.000000 7471.1200 63.8557
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Number of Children (Unduplicated) With at Least One Service 21
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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 5 9.000000 636.0000 433.4800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 11 21.500000 1612.5000 0.0000
T 32 61.500000 3670.7800 3475.7800
13 25.000000 1551.8400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 61 117.000000 7471.1200 3909.2600