CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2025 ending 12/31/2025 Date of Report:01/07/2026 Page: 1
List order: No List
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 5764 18046.25000 816261.1800 45.2316
Subtotal (Total Children Is Unduplicated) 5764 18046.25000 816261.1800 45.2316
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Screening, Eval, and Assessment,Class #02
AACIS-92597-AAC INTIAL EVAL BY LICENSED SLP 1 1.000000 116.8300 116.8300
AACIS-92597TL-AAC INTIAL EVAL BY LICENSED SLP 2 2.000000 233.6600 116.8300
AUDE-92558-OTOACOUSTIC EMISSIONS (SCREENING) 2 2.000000 13.7400 6.8700
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 53 103.000000 8340.9400 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 4 8.000000 647.8400 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 7 12.000000 971.7600 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 4.000000 323.9200 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 10 18.500000 1498.1300 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 4.000000 323.9200 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 27 53.500000 3205.7200 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 7 13.000000 778.9600 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 9 17.500000 1417.1500 80.9800
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 544 1004.000000 81222.9400 80.8993
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 134 209.500000 16965.3100 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 184 336.500000 27184.1000 80.7848
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 82 137.500000 11134.7500 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 148 269.500000 21824.1100 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 40 76.500000 6194.9700 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 399 731.500000 43799.9200 59.8769
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 162 254.000000 15219.6800 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 134 219.500000 17623.3700 80.2887
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 43 66.000000 5344.6800 80.9800
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 116.2200 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97161TL-PT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97163TL-PT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
SCREEN-T1023-SCREENING 4 4.000000 215.9200 53.9800
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 1.000000 58.1100 58.1100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 6 30.000000 1743.3000 58.1100
Subtotal (Total Children Is Unduplicated) 1197 3586.000000 266914.3500 74.4323
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EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 1 1.000000 47.9400 47.9400
AACFIT-92609TL-AAC FITTING, ADJUST, TRAINING VISIT 1 1.000000 47.9400 47.9400
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 6 9.000000 243.0000 27.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 303 1210.750000 65474.9600 54.0780
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 20 29.000000 1566.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 6 8.000000 650.5600 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 2 2.000000 162.6400 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 1 1.000000 65.1200 65.1200
OCCT-97530TL-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
OCCT-97530TLGO-OT SESSION BY LICENSED OT 119 388.500000 31592.8200 81.3200
OCCT-97530TLGOGT-OT SESSION BY LICENSED OT 15 14.500000 1179.1400 81.3200
OCCT-97530TLGTHM-OT SESSION BY OT ASST 6 9.000000 586.0800 65.1200
OCCT-97530TLHM-OT SESSION BY OT ASST 22 87.000000 5665.4400 65.1200
PHY-97110-PT SESSION BY LICENSED PT 2 2.000000 162.6400 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 81.3200 81.3200
PHY-97110HM-PT SESSION BY PT ASST 1 1.500000 97.6800 65.1200
PHY-97110TL-PT SESSION BY LICENSED PT 99 390.750000 31775.7900 81.3200
PHY-97110TLGP-PT SESSION BY LICENSED PT 2 2.000000 162.6400 81.3200
PHY-97110TLGPGT-PT SESSION BY LICENSED PT 2 2.000000 162.6400 81.3200
PHY-97110TLGT-PT SESSION BY LICENSED PT 3 2.500000 203.3000 81.3200
PHY-97110TLHM-PT SESSION BY PT ASST 2 7.000000 455.8400 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 23 45.500000 3700.0600 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 3.250000 264.2900 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 106 356.750000 29010.9100 81.3200
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 18 29.750000 2326.9600 78.2171
Subtotal (Total Children Is Unduplicated) 625 2605.750000 175767.0300 67.4535
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Total 24238.000000 1258942.5600 51.9409
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Number of Children (Unduplicated) With at Least One Service 6008
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Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 113 204.250000 9344.3800 0.0000
U 0 0.000000 0.0000 0.0000
B 995 1647.250000 78084.6700 0.0000
P 543 876.250000 44127.4400 42009.8700
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 1651 2727.750000 131556.4900 42009.8700
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.250000 11.4200 0.0000
U 0 0.000000 0.0000 0.0000
B 2747 1456.750000 66542.2200 31822.2000
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 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2748 1457.000000 66553.6400 31822.2000
Center 06
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 2.000000 89.2400 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 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3 2.000000 89.2400 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 65 50.750000 2318.2600 0.0000
U 0 0.000000 0.0000 0.0000
B 390 386.750000 21112.1600 0.0000
P 1477 1409.000000 75340.5600 73994.8800
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 1932 1846.500000 98770.9800 73994.8800
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 117 107.750000 5010.4900 0.0000
U 0 0.000000 0.0000 0.0000
B 7274 6887.250000 351877.0700 0.0000
P 29 48.250000 3431.4300 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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7420 7043.250000 360318.9900 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 23 15.250000 746.5400 0.0000
U 0 0.000000 0.0000 0.0000
B 903 945.000000 49050.2400 0.0000
P 755 843.250000 47831.6500 47517.2500
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 1681 1803.500000 97628.4300 47517.2500
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 141 120.000000 6361.3000 0.0000
U 0 0.000000 0.0000 0.0000
B 1714 1655.750000 96766.1300 37.2000
P 997 941.000000 56263.5400 55806.4200
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 2852 2716.750000 159390.9700 55843.6200
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 84 81.500000 4352.0200 0.0000
U 0 0.000000 0.0000 0.0000
B 2300 2196.750000 114038.8200 0.0000
P 1393 1314.750000 72050.1900 71255.2700
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 3777 3593.000000 190441.0300 71255.2700
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3082 3048.250000 154192.7900 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 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3082 3048.250000 154192.7900 0.0000