CMS/EIP Fiscal Report Center: 52
Services beginning 10/01/2015 ending 12/31/2015 Date of Report:02/13/2016 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 8.7500 8.7500
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 4 4.000000 204.2000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 6 6.000000 293.5300 48.9217
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 14 16.000000 857.5300 53.5956
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6 16.000000 800.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 10 44.250000 2994.7600 67.6782
PHY-97110-PT SESSION BY LICENSED PT 10 59.750000 4152.0400 69.4902
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 26 111.500000 6348.5300 56.9375
Subtotal (Total Children Is Unduplicated) 48 231.500000 14295.3300 61.7509
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Total 247.500000 15152.8600 61.2237
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Number of Children (Unduplicated) With at Least One Service 57
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Center 52
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 0 0.000000 0.0000 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 19 22.000000 1550.6500 276.5400
147 225.500000 13602.2100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 166 247.500000 15152.8600 276.5400