CMS/EIP Fiscal Report Center: 10
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-92552-PURE TONE AUDIOMETRY -AIR ONLY 5 5.00 57.35 11.47
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 3 3.00 48.90 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 8 8.00 66.79 8.35
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 7 8.00 79.13 9.89
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 6 7.00 145.61 20.80
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.00 47.54 47.54
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.00 58.91 19.64
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 10 19.00 1425.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 7.50 562.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.00 225.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 12.00 900.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 12.50 693.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 64 117.50 8812.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 44 81.00 6075.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 14 25.00 1875.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 46 90.00 4995.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 32 47.00 3525.00 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 7 9.00 438.00 48.67
SPCH-92506-SPEECH EVAL BY LICENSED SLP 5 6.00 291.00 48.50
Subtotal (Total Children Is Unduplicated) 124 464.50 30321.98 65.28
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 32.00 4135.76 129.24
AUD-HA_FUP-AUDIOLOGY SERVICES 1 1.00 50.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 109 479.50 31958.12 66.65
OCCT-97530HM-OT SESSION BY OT ASST 5 11.75 636.58 54.18
PHY-97110-PT SESSION BY LICENSED PT 114 446.75 29594.66 66.24
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 157 523.75 34866.36 66.57
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 10 21.50 1187.24 55.22
Subtotal (Total Children Is Unduplicated) 249 1516.25 102428.72 67.55
----------------------------------------------------------------------------------------------------------------
Total 1980.75 132750.70 67.02
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 335
----------------------------------------------------------------------------------------------------------------
Center 10
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
1239 1980.75 132750.70 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1239 1980.75 132750.70 0.00