CMS/EIP Fiscal Report Center: 09
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 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 1.500000 121.4700 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 7 13.500000 1048.3800 77.6578
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.500000 445.3900 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.000000 350.6800 58.4467
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 6 12.000000 692.5200 57.7100
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 17 27.500000 2062.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 7.500000 598.3800 79.7840
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 15.500000 1162.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 18 33.000000 2570.6800 77.8994
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 10.500000 811.4200 77.2781
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 5.000000 383.9700 76.7940
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 32 54.500000 3171.3900 58.1906
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 34 62.000000 3571.3900 57.6031
Subtotal (Total Children Is Unduplicated) 84 254.000000 16990.6700 66.8924
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Total 254.000000 16990.6700 66.8924
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Number of Children (Unduplicated) With at Least One Service 84
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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 91 166.000000 11279.6100 8930.6100
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 43 73.000000 4737.6400 4737.6400
T 0 0.000000 0.0000 0.0000
2 3.500000 245.2100 83.2500
Other 6 11.500000 728.2100 0.0000
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Total 142 254.000000 16990.6700 13751.5000