CMS/EIP Fiscal Report Center: 57
Services beginning 10/01/2021 ending 12/31/2021 Date of Report:02/04/2022 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-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 28 44.000000 3170.0000 72.0455
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 6 8.500000 587.5000 69.1176
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 11 15.000000 1025.0000 68.3333
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 41 62.500000 3291.2800 52.6605
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 6.500000 437.5000 67.3077
Subtotal (Total Children Is Unduplicated) 46 136.500000 8511.2800 62.3537
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 14.000000 700.0000 50.0000
Subtotal (Total Children Is Unduplicated) 1 14.000000 700.0000 50.0000
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Total 150.500000 9211.2800 61.2045
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Number of Children (Unduplicated) With at Least One Service 46
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Center 57
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 2 3.000000 195.7500 312.4600
D 2 2.000000 130.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 17 38.000000 1797.5300 700.0000
72 107.500000 7087.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 93 150.500000 9211.2800 1012.4600