CMS/EIP Fiscal Report Center: 10
Services beginning 01/01/2025 ending 03/31/2025 Date of Report:04/06/2025 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
Payclass Filters:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 13 27.000000 2186.4600 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 7.500000 566.8600 75.5813
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 10.000000 809.8000 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 5 11.000000 659.1200 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 140 310.000000 25063.3100 80.8494
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.500000 526.3700 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 32 68.500000 5547.1300 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 28 59.000000 4737.3300 80.2937
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 119 256.500000 15369.4800 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 31 67.000000 5425.6600 80.9800
Subtotal (Total Children Is Unduplicated) 176 825.000000 61053.4800 74.0042
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Total 825.000000 61053.4800 74.0042
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Number of Children (Unduplicated) With at Least One Service 176
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Center 10
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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 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
382 825.000000 61053.4800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 382 825.000000 61053.4800 0.0000