CMS/EIP Fiscal Report Center: 57
Services beginning 01/01/2023 ending 03/31/2023 Date of Report:04/20/2023 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
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 32 54.000000 4024.7500 74.5324
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 9 13.000000 975.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 16 23.500000 1762.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 46 77.500000 4301.2500 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 17.000000 1275.0000 75.0000
Subtotal (Total Children Is Unduplicated) 57 185.000000 12338.5000 66.6946
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Total 185.000000 12338.5000 66.6946
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Number of Children (Unduplicated) With at Least One Service 57
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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 341.1200
D 1 1.500000 112.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
110 180.500000 12030.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 113 185.000000 12338.5000 341.1200