CMS/EIP Fiscal Report Center: 53
Services beginning 10/01/2011 ending 12/31/2011 Date of Report:02/16/2012 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 10.3800 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 21.0800 21.0800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 8.000000 444.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 22.500000 1687.5000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 0.643710 31.2199 48.4999
PSTH-97001-EVAL BY LICENSED PT, INITIAL 4 5.000000 242.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 10 10.000000 485.0000 48.5000
Subtotal (Total Children Is Unduplicated) 24 54.143710 3371.6799 62.2728
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6 29.000000 1450.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 9 51.511570 3496.6052 67.8800
OCCT-97530HM-OT SESSION BY OT ASST 4 17.000000 923.4400 54.3200
PHY-97110-PT SESSION BY LICENSED PT 17 95.926760 6511.5085 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 11 68.000000 4615.8400 67.8800
SPL-92508-GROUP SPL SESSION PER CHILD 2 4.000000 52.8000 13.2000
Subtotal (Total Children Is Unduplicated) 42 265.438330 17050.1937 64.2341
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Total 319.582040 20421.8736 63.9018
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Number of Children (Unduplicated) With at Least One Service 58
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Center 53
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 20 22.000000 1343.0400 1343.0400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 18 18.000000 1043.0400 1043.0400
T 0 0.000000 0.0000 0.0000
272 279.582040 18035.7936 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 310 319.582040 20421.8736 2386.0800