CMS/EIP Fiscal Report Center: 01
Services beginning 07/01/2024 ending 09/30/2024 Date of Report:04/06/2025 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-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 5.500000 412.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 6 7.500000 498.3400 66.4453
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 2.500000 187.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 2.000000 161.9600 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 7.500000 580.4400 77.3920
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 25 42.500000 2383.0600 56.0720
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 14 20.000000 1136.5200 56.8260
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 24.000000 1826.9100 76.1213
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 22.500000 1708.4300 75.9302
Subtotal (Total Children Is Unduplicated) 52 144.000000 9616.4100 66.7806
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 3.000000 150.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 4.000000 200.0000 50.0000
INTR-T1013-INTERPRETER 1 1.500000 75.0000 50.0000
Subtotal (Total Children Is Unduplicated) 2 8.500000 425.0000 50.0000
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Total 152.500000 10041.4100 65.8453
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Number of Children (Unduplicated) With at Least One Service 53
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Center 01
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 38 59.000000 3584.4000 3584.4000
D 1 2.000000 150.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 56 82.000000 5637.2800 0.0000
T 0 0.000000 0.0000 0.0000
7 9.500000 669.7300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 102 152.500000 10041.4100 3584.4000