CMS/EIP Fiscal Report Center: 03
Services beginning 07/01/2022 ending 06/30/2023 Date of Report:07/25/2023 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 2 3.500000 262.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.000000 166.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 21 37.000000 2701.0000 73.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 30 56.500000 4122.1100 72.9577
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 27 48.000000 3490.0000 72.7083
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 32 54.000000 2997.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 12.000000 900.0000 75.0000
Subtotal (Total Children Is Unduplicated) 91 216.000000 14789.1100 68.4681
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Total 216.000000 14789.1100 68.4681
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Number of Children (Unduplicated) With at Least One Service 91
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Center 03
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 66 120.000000 8193.8600 8193.8600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 6 11.000000 727.5000 727.5000
T 0 0.000000 0.0000 0.0000
50 85.000000 5867.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 122 216.000000 14789.1100 8921.3600