CMS/EIP Fiscal Report Center: 57
Services beginning 01/01/2022 ending 03/31/2022 Date of Report:04/16/2022 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-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 27 44.500000 3287.5000 73.8764
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 10 17.000000 1275.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 13 22.000000 1620.7500 73.6705
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 42 71.500000 3943.2500 55.1503
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 11.000000 825.0000 75.0000
Subtotal (Total Children Is Unduplicated) 51 168.000000 11101.5000 66.0804
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Total 168.000000 11101.5000 66.0804
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Number of Children (Unduplicated) With at Least One Service 51
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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 0 0.000000 0.0000 0.0000
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 1 1.500000 83.2500 0.0000
99 166.500000 11018.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 100 168.000000 11101.5000 0.0000