CMS/EIP Fiscal Report Center: 52
Services beginning 01/01/2025 ending 03/31/2025 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-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 119.8400 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 17 36.000000 2718.3200 75.5089
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 485.8800 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 8.000000 647.8400 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 18.000000 1280.6800 71.1489
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 15 30.000000 1797.6000 59.9200
Subtotal (Total Children Is Unduplicated) 25 102.000000 7212.1200 70.7071
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Total 102.000000 7212.1200 70.7071
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Number of Children (Unduplicated) With at Least One Service 25
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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 2 4.000000 110.0000 110.0000
D 3 6.000000 485.8800 0.0000
S 0 0.000000 0.0000 0.0000
H 6 12.000000 971.7600 0.0000
T 17 34.000000 2382.7200 2337.7200
23 46.000000 3261.7600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 51 102.000000 7212.1200 2447.7200