CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2024 ending 03/31/2024 Date of Report:04/04/2025 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-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 7 12.000000 900.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 11 20.000000 1500.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 4 7.500000 562.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 22 41.500000 2303.2500 55.5000
Subtotal (Total Children Is Unduplicated) 33 83.000000 5376.7500 64.7801
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Total 83.000000 5376.7500 64.7801
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Number of Children (Unduplicated) With at Least One Service 33
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Center 09
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 12 24.000000 1605.0000 1605.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 32 57.000000 3621.7500 3621.7500
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 1 2.000000 150.0000 150.0000
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Total 45 83.000000 5376.7500 5376.7500