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
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 598 2556.000000 115727.8400 45.2769
Subtotal (Total Children Is Unduplicated) 598 2556.000000 115727.8400 45.2769
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Screening, Eval, and Assessment,Class #02
AUDE-92558-OTOACOUSTIC EMISSIONS (SCREENING) 1 1.000000 6.8700 6.8700
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 10 17.500000 1417.1500 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 1.500000 121.4700 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 4.500000 364.4100 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 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 6 11.500000 689.0800 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 6 11.500000 689.0800 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 323.9200 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 219 384.000000 31096.3200 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 48 70.000000 5668.6000 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 106 174.000000 14090.5200 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 59 92.500000 7409.6700 80.1045
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 72 126.500000 10243.9700 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 21 39.000000 3158.2200 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 214 363.000000 21750.9600 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 100 168.000000 10006.6400 59.5633
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 47 76.000000 6046.5200 79.5595
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 28 44.500000 3603.6100 80.9800
Subtotal (Total Children Is Unduplicated) 525 1595.000000 117172.8900 73.4626
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 11.000000 594.0000 54.0000
Subtotal (Total Children Is Unduplicated) 2 11.000000 594.0000 54.0000
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Total 4162.000000 233494.7300 56.1016
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Number of Children (Unduplicated) With at Least One Service 684
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Center 01
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 0 0.000000 0.0000 0.0000
D 3 5.000000 299.6000 0.0000
S 53 50.500000 2649.9100 0.0000
H 94 127.750000 8927.9700 8927.9700
T 0 0.000000 0.0000 0.0000
1 1.500000 89.8800 0.0000
Other 3 4.250000 247.0900 0.0000
---------------------------------------------------------
Total 154 189.000000 12214.4500 8927.9700
Center 03
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 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
54 69.750000 3787.7800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 54 69.750000 3787.7800 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 10 23.000000 1050.6400 0.0000
U 0 0.000000 0.0000 0.0000
B 67 121.250000 5767.2500 0.0000
P 30 50.500000 2715.4400 2584.4000
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
41 47.500000 3509.5900 0.0000
Other 1 2.500000 114.2000 0.0000
---------------------------------------------------------
Total 149 244.750000 13157.1200 2584.4000
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 297 230.750000 10540.6600 3768.2700
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
2 2.250000 102.7800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 299 233.000000 10643.4400 3768.2700
Center 06
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 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
186 181.000000 9978.3500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 186 181.000000 9978.3500 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 2.250000 102.7800 0.0000
U 0 0.000000 0.0000 0.0000
B 20 31.500000 1934.3200 0.0000
P 134 162.250000 9186.2600 9122.7000
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
3 5.250000 239.8200 0.0000
Other 10 13.750000 868.3800 0.0000
---------------------------------------------------------
Total 170 215.000000 12331.5600 9122.7000
Center 09
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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 94 150.750000 8730.9700 8730.9700
T 0 0.000000 0.0000 0.0000
89 156.250000 8971.7200 0.0000
Other 16 29.000000 1909.4200 0.0000
---------------------------------------------------------
Total 199 336.000000 19612.1100 8730.9700
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 18 21.250000 1099.4500 0.0000
U 0 0.000000 0.0000 0.0000
B 584 796.750000 45566.1000 0.0000
P 7 9.750000 717.5500 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
1 0.250000 11.4200 0.0000
Other 9 8.000000 365.4400 0.0000
---------------------------------------------------------
Total 619 836.000000 47759.9600 0.0000
Center 51
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 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
8 11.000000 890.7800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8 11.000000 890.7800 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 51 80.250000 4231.8200 0.0000
P 41 65.750000 3768.8200 3700.9800
D 0 0.000000 0.0000 0.0000
S 41 37.500000 1710.8800 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
15 23.500000 1101.9600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 148 207.000000 10813.4800 3700.9800
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.250000 102.7800 0.0000
U 0 0.000000 0.0000 0.0000
B 107 138.250000 7979.5700 0.0000
P 36 50.250000 2523.4100 2489.4900
D 6 5.500000 251.2400 204.6000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
18 28.750000 1841.4900 0.0000
Other 8 8.000000 414.8400 83.7000
---------------------------------------------------------
Total 177 233.000000 13113.3300 2777.7900
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 8.250000 251.2400 0.0000
U 0 0.000000 0.0000 0.0000
B 213 274.750000 13905.3600 0.0000
P 128 158.750000 8245.6400 8082.8000
D 8 8.750000 399.7000 325.5000
S 25 24.250000 1090.7800 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
38 68.500000 4767.9100 0.0000
Other 8 11.500000 525.3200 399.9000
---------------------------------------------------------
Total 425 554.750000 29185.9500 8808.2000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 203 427.500000 25111.4000 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
45 96.000000 7126.2400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 248 523.500000 32237.6400 0.0000
Center 57
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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 152 281.250000 15317.0800 15317.0800
T 0 0.000000 0.0000 0.0000
26 47.000000 2451.7000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 178 328.250000 17768.7800 15317.0800