CMS/EIP Fiscal Report Center: 10
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
Agency Filter:EXT
Payclass Filters:TPIN
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 2 2.00 21.24 10.62
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 2 2.00 17.66 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 2.00 21.18 10.59
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 4 4.00 87.16 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.00 84.84 28.28
Subtotal (Total Children Is Unduplicated) 4 13.00 232.08 17.85
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 3.00 150.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 91 343.25 23259.13 67.76
OCCT-97530HM-OT SESSION BY OT ASST 5 10.50 570.36 54.32
PHY-97110-PT SESSION BY LICENSED PT 108 373.00 25319.24 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 161 543.50 36892.78 67.88
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 6 10.00 543.20 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 3 5.00 66.00 13.20
Subtotal (Total Children Is Unduplicated) 240 1288.25 86800.71 67.38
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Total 1301.25 87032.79 66.88
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Number of Children (Unduplicated) With at Least One Service 240
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Center 10
Flag Claims Units Chgs Paid
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R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 1 1.50 101.82 0.00
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
786 1299.75 86930.97 0.00
Other 0 0.00 0.00 0.00
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Total 787 1301.25 87032.79 0.00