CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 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-92555-SPEECH AUD THRESHOLD (DETECTION) 20 21.00 185.43 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 16 18.00 194.40 10.80
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 23 25.00 544.75 21.79
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 2 2.00 108.76 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.00 56.56 28.28
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 15 16.00 508.96 31.81
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 2 2.00 97.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 6 6.00 291.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 17 18.00 873.00 48.50
Subtotal (Total Children Is Unduplicated) 41 110.00 2859.86 26.00
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EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 18 85.50 5803.74 67.88
PHY-97110-PT SESSION BY LICENSED PT 24 160.93 10923.59 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 30 116.00 7874.08 67.88
Subtotal (Total Children Is Unduplicated) 57 362.43 24601.41 67.88
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Total 472.43 27461.27 58.13
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Number of Children (Unduplicated) With at Least One Service 81
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Center 53
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 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
688 472.43 27461.27 0.00
Other 0 0.00 0.00 0.00
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Total 688 472.43 27461.27 0.00