CMS/EIP Fiscal Report Center: 06
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
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-92555-SPEECH AUD THRESHOLD (DETECTION) 67 67.00 591.61 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 68 68.00 734.40 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 67 67.00 1459.93 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.00 56.56 28.28
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.00 150.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 0.50 37.50 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 119 169.50 12712.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 99 149.00 11175.00 75.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 11.00 825.00 75.00
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 2 2.00 54.44 27.22
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 7 7.00 400.89 57.27
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 157 547.00 28294.83 51.73
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.00 50.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 7 19.00 950.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 37 103.00 7675.13 74.52
OCCT-97530HM-OT SESSION BY OT ASST 4 3.50 791.32 226.09
PHY-97110-PT SESSION BY LICENSED PT 53 170.50 11767.20 69.02
PHY-97110HM-PT SESSION BY PT ASST 5 9.50 726.36 76.46
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 153 467.75 31823.46 68.04
SPL-92508-GROUP SPL SESSION PER CHILD 2 4.00 52.80 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 2 112.00 56.00 0.50
Subtotal (Total Children Is Unduplicated) 219 890.25 53892.27 60.54
----------------------------------------------------------------------------------------------------------------
Total 1437.25 82187.10 57.18
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 336
----------------------------------------------------------------------------------------------------------------
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
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 0 0.00 0.00 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
1592 1437.25 82187.10 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1592 1437.25 82187.10 0.00