CMS/EIP Fiscal Report Center: 52
Services beginning 10/01/2020 ending 12/31/2020 Date of Report:01/23/2021 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-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 1.000000 75.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 3.500000 194.2500 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 15 31.500000 2192.5000 69.6032
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 6 12.000000 900.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 8 19.500000 1302.5000 66.7949
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 15 29.000000 1609.5000 55.5000
Subtotal (Total Children Is Unduplicated) 20 98.500000 6384.7500 64.8198
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Total 98.500000 6384.7500 64.8198
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Number of Children (Unduplicated) With at Least One Service 20
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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 4 8.000000 456.0000 398.4400
D 7 13.000000 721.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 12 24.000000 1683.0000 0.0000
T 19 36.000000 2406.7500 2226.7500
9 17.500000 1117.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 51 98.500000 6384.7500 2625.1900