CMS/EIP Fiscal Report Center: 52
Services beginning 10/01/2023 ending 12/31/2023 Date of Report:01/14/2024 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 16 33.500000 2347.7000 70.0806
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 5 10.000000 750.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 16.000000 1200.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 14.500000 1087.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 16 30.000000 1665.0000 55.5000
Subtotal (Total Children Is Unduplicated) 27 110.000000 7500.2000 68.1836
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Total 110.000000 7500.2000 68.1836
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Number of Children (Unduplicated) With at Least One Service 27
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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 5 9.000000 640.1600 562.1500
D 3 6.000000 450.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 8 15.500000 1162.5000 0.0000
T 21 42.000000 2825.0400 2632.6400
20 37.500000 2422.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 57 110.000000 7500.2000 3194.7900