CMS/EIP Fiscal Report Center: 51
Services beginning 07/01/2022 ending 06/30/2023 Date of Report:07/25/2023 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
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-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 4.500000 222.0000 49.3333
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 69 94.500000 5244.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 26 39.500000 2192.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 15.500000 1162.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 7.000000 525.0000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 2.000000 97.5000 48.7500
Subtotal (Total Children Is Unduplicated) 119 167.500000 9781.5000 58.3970
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Total 167.500000 9781.5000 58.3970
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Number of Children (Unduplicated) With at Least One Service 119
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Center 51
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 36 49.500000 3119.2500 0.0000
P 1 2.000000 97.5000 97.5000
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
83 116.000000 6564.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 120 167.500000 9781.5000 97.5000