CMS/EIP Fiscal Report Center: 10
Services beginning 10/01/2013 ending 12/31/2013 Date of Report:02/18/2014 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:GR
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 30 32.000000 459.5200 14.3600
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 18.4600 18.4600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 31 33.000000 330.6600 10.0200
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 31 33.000000 277.5300 8.4100
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 31 33.000000 693.0000 21.0000
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.000000 62.6300 62.6300
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 20 22.000000 484.4400 22.0200
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 14 14.000000 679.0000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 48.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 14 14.000000 679.0000 48.5000
Subtotal (Total Children Is Unduplicated) 59 184.000000 3732.7400 20.2866
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 11.000000 7027.8800 638.8982
AUD-HA_FUP-AUDIOLOGY SERVICES 1 1.000000 50.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 176 173.500000 8675.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 2 1.000000 25.0000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 18 11.750000 587.5000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 4 2.000000 50.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 32 27.000000 1350.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 3 1.250000 31.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 40 36.250000 1812.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.500000 12.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 50 46.000000 2300.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 23 15.250000 381.2500 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 6.000000 150.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 316 3379.750000 168987.5000 50.0000
INTR-INTR-INTERPRETER 6 40.500000 2025.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 147 774.750000 51927.6500 67.0250
OCCT-97530HM-OT SESSION BY OT ASST 14 59.250000 3104.4000 52.3949
PHY-97110-PT SESSION BY LICENSED PT 152 774.750000 51289.6200 66.2015
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 267 1624.750000 108886.7100 67.0175
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 14 56.000000 3041.9200 54.3200
TRAV-FLAT-PROV TRAVEL TO NATL ENV $10 PER CHILD 1088 14104.00000 141040.0000 10.0000
Subtotal (Total Children Is Unduplicated) 1254 21148.25000 552791.6800 26.1389
-----------------------------------------------------------------------------------------------------------------------
Total 21332.250000 556524.4200 26.0884
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1263
-----------------------------------------------------------------------------------------------------------------------
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 7133 21332.250000 556524.4200 556524.4200
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7133 21332.250000 556524.4200 556524.4200