CMS/EIP Fiscal Report Center: 10
Services beginning 10/01/2012 ending 12/31/2012 Date of Report:02/16/2013 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:MED
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-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 13.0500 13.0500
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 9.1100 9.1100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 9.3400 9.3400
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 21.7300 21.7300
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 24.4700 24.4700
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 3 3.000000 145.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 48.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 3 3.000000 145.5000 48.5000
Subtotal (Total Children Is Unduplicated) 7 12.000000 417.2000 34.7667
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 476 4147.500000 207375.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 98 466.500000 31547.2300 67.6254
OCCT-97530HM-OT SESSION BY OT ASST 6 15.500000 841.9600 54.3200
PHY-97110-PT SESSION BY LICENSED PT 177 701.000000 47583.8800 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 126 589.750000 40032.2300 67.8800
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 2 5.500000 298.7600 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 2 4.500000 59.4000 13.2000
Subtotal (Total Children Is Unduplicated) 697 5930.250000 327738.4600 55.2655
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Total 5942.250000 328155.6600 55.2241
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Number of Children (Unduplicated) With at Least One Service 698
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Center 10
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 1 1.000000 67.8800 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2101 5941.250000 328087.7800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2102 5942.250000 328155.6600 0.0000