CMS/EIP Fiscal Report Center: 10
Services beginning 01/01/2020 ending 03/31/2020 Date of Report:05/15/2020 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-92552-PURE TONE AUDIOMETRY -AIR ONLY 17 19.000000 333.0300 17.5279
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 23.7700 23.7700
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 25 27.000000 366.7500 13.5833
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 16 17.000000 157.6300 9.2724
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 26 28.000000 749.8400 26.7800
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 4 4.000000 77.0100 19.2525
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 7 7.000000 144.8300 20.6900
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 45.0000 45.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 4.000000 153.1500 38.2875
OCTH-97167-OT EVAL HIGH COMPLEXITY 6 7.000000 300.2500 42.8929
PSTH-97163-PT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 4.000000 153.1500 38.2875
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 5 5.000000 255.2500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 2 5.000000 108.1500 21.6300
Subtotal (Total Children Is Unduplicated) 44 131.000000 2969.9100 22.6711
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 12.000000 600.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 75 390.500000 24595.4500 62.9845
OCCT-97530GT-OT SESSION BY LICENSED OT 5 6.750000 410.7800 60.8563
OCCT-97530HM-OT SESSION BY OT ASST 4 11.500000 572.0000 49.7391
PHY-97110-PT SESSION BY LICENSED PT 109 533.750000 36891.9000 69.1183
PHY-97110GT-PT SESSION BY LICENSED PT 6 7.500000 500.0800 66.6773
PHY-97110HM-PT SESSION BY PT ASST 2 3.500000 142.9400 40.8400
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 100 471.250000 30797.6100 65.3530
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 6 6.750000 446.5000 66.1481
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 5 6.000000 343.2000 57.2000
Subtotal (Total Children Is Unduplicated) 212 1451.500000 95336.4600 65.6813
-----------------------------------------------------------------------------------------------------------------------
Total 1582.500000 98306.3700 62.1209
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 242
-----------------------------------------------------------------------------------------------------------------------
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 803 589.000000 32267.5700 32267.5700
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
675 993.500000 66038.8000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1478 1582.500000 98306.3700 32267.5700