CMS/EIP Fiscal Report Center: 55
Services beginning 10/01/2024 ending 12/31/2024 Date of Report:03/31/2025 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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 15 29.000000 2348.4200 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 10.000000 809.8000 80.9800
Subtotal (Total Children Is Unduplicated) 17 43.000000 3482.1400 80.9800
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Total 43.000000 3482.1400 80.9800
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Number of Children (Unduplicated) With at Least One Service 17
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Center 55
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 10.000000 809.8000 809.8000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 13 25.000000 2024.5000 0.0000
T 0 0.000000 0.0000 0.0000
4 8.000000 647.8400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 22 43.000000 3482.1400 809.8000