CMS/EIP Fiscal Report Center: 57
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-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 4 7.500000 562.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 7.000000 388.5000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 117 196.500000 14221.2700 72.3729
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 33 52.500000 3937.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 44 69.500000 4980.2300 71.6580
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 151 262.000000 14291.0000 54.5458
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 27 45.000000 3154.0900 70.0909
Subtotal (Total Children Is Unduplicated) 192 644.000000 41835.0900 64.9613
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Total 644.000000 41835.0900 64.9613
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Number of Children (Unduplicated) With at Least One Service 192
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Center 57
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 14 25.000000 1650.7500 2883.7600
D 57 95.500000 6265.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 7 13.500000 1012.5000 1012.5000
304 510.000000 32906.3400 150.0000
Other 0 0.000000 0.0000 0.0000
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Total 382 644.000000 41835.0900 4046.2600