CMS/EIP Fiscal Report Center: 52
Services beginning 10/01/2022 ending 12/31/2022 Date of Report:01/23/2023 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-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 17 36.000000 2530.0000 70.2778
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 18.000000 1200.0000 66.6667
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 17 34.000000 1887.0000 55.5000
Subtotal (Total Children Is Unduplicated) 19 96.000000 6178.0000 64.3542
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Total 96.000000 6178.0000 64.3542
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Number of Children (Unduplicated) With at Least One Service 19
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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 7 14.000000 903.0000 552.4900
D 10 20.000000 1266.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 7 14.000000 1050.0000 0.0000
T 9 18.000000 1000.5500 920.5500
15 30.000000 1958.4500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 48 96.000000 6178.0000 1473.0400