CMS/EIP Fiscal Report Center: 10
Services beginning 07/01/2019 ending 09/30/2019 Date of Report:11/04/2019 Page: 1
List order: No List
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-92552-PURE TONE AUDIOMETRY -AIR ONLY 14 14.000000 275.0400 19.6457
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 16 17.000000 265.7500 15.6324
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 14 15.000000 132.5700 8.8380
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 15 15.000000 435.0600 29.0040
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.000000 43.9300 14.6433
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 7 7.000000 144.8300 20.6900
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 15.500000 1162.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 6.500000 487.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 10 26.500000 1470.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 125 282.000000 21150.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 40 85.000000 6401.2500 75.3088
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 27 51.500000 3862.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 127 300.000000 16650.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 21 68.000000 5100.0000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 2 4.000000 102.1000 25.5250
PSTH-97163-PT EVAL HIGH COMPLEXITY 2 3.000000 102.1000 34.0333
SPCH-92521-EVAL OF SPEECH FLUENCY 1 2.000000 51.0500 25.5250
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 204.2000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 195 922.000000 58194.2800 63.1174
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 6.000000 730.6200 121.7700
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 1.500000 75.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 55 329.250000 20314.7300 61.7000
OCCT-97530HM-OT SESSION BY OT ASST 2 1.000000 57.2000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 75 397.750000 26563.7200 66.7850
PHY-97110HM-PT SESSION BY PT ASST 3 5.750000 328.6700 57.1600
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 73 346.250000 23690.6500 68.4206
SPL-92508-GROUP SPL SESSION PER CHILD 2 3.500000 48.5800 13.8800
Subtotal (Total Children Is Unduplicated) 148 1093.000000 71845.1700 65.7321
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Total 2015.000000 130039.4500 64.5357
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Number of Children (Unduplicated) With at Least One Service 312
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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 471 375.500000 20050.4000 20050.4000
D 0 0.000000 0.0000 0.0000
S 4 7.500000 535.8000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
889 1632.000000 109453.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1364 2015.000000 130039.4500 20050.4000