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:TPIN
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 16.500000 1336.1700 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 7.500000 607.3500 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.500000 364.4100 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 5 10.000000 599.2000 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 3 4.000000 323.9200 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 150 261.000000 21054.8000 80.6697
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 33 50.500000 4089.4900 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 80 140.000000 11337.2000 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 29 49.500000 4008.5100 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 46 93.000000 7207.2200 77.4970
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 13 23.500000 1903.0300 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 129 224.500000 13443.2000 59.8806
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 57 102.000000 6111.8400 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 38 66.000000 5344.6800 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 16 26.000000 2105.4800 80.9800
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 2 2.000000 608.0000 304.0000
Subtotal (Total Children Is Unduplicated) 349 1084.500000 80726.3000 74.4364
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 1 1.000000 0.0000 0.0000
INTR-T1013-INTERPRETER 1 1.000000 50.0000 50.0000
OCCT-97530HM-OT SESSION BY OT ASST 1 6.000000 390.7200 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 162.6400 81.3200
Subtotal (Total Children Is Unduplicated) 3 10.000000 603.3600 60.3360
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Total 1094.500000 81329.6600 74.3076
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Number of Children (Unduplicated) With at Least One Service 351
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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 16 25.500000 1718.1100 1718.1100
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 34 56.000000 4008.3800 0.0000
T 1 2.000000 119.8400 119.8400
2 2.000000 140.9000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 53 85.500000 5987.2300 1837.9500
Center 02
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 3 6.000000 485.8800 485.8800
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3 6.000000 485.8800 485.8800
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
4 8.000000 647.8400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4 8.000000 647.8400 0.0000
Center 04
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
56 66.000000 5790.7200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 56 66.000000 5790.7200 0.0000
Center 05
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 1 2.000000 161.9600 161.9600
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 1 2.000000 161.9600 161.9600
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
29 35.000000 2613.1700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 29 35.000000 2613.1700 0.0000
Center 07
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 13 26.000000 2105.4800 1963.7400
D 3 6.000000 485.8800 0.0000
S 0 0.000000 0.0000 0.0000
H 2 4.000000 323.9200 0.0000
T 0 0.000000 0.0000 0.0000
13 25.000000 1943.5200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 31 61.000000 4858.8000 1963.7400
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 40 72.500000 5008.2700 5008.2700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2 3.000000 179.7600 179.7600
T 36 59.500000 4102.2700 4102.2700
27 44.500000 3150.4300 0.0000
Other 20 37.000000 2575.0600 0.0000
---------------------------------------------------------
Total 125 216.500000 15015.7900 9290.3000
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 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
186 320.500000 23767.1100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 186 320.500000 23767.1100 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 0 0.000000 0.0000 0.0000
P 3 6.000000 418.4000 266.7600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2 4.000000 323.9200 0.0000
T 15 30.000000 1995.6400 1944.4800
14 28.000000 2098.9600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 34 68.000000 4836.9200 2211.2400
Center 53
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 4.500000 269.6400 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
12 21.000000 1668.9900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15 25.500000 1938.6300 0.0000
Center 54
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 2 4.000000 239.6800 239.6800
17 33.000000 2524.9200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 19 37.000000 2764.6000 239.6800
Center 55
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
41 82.000000 6640.3600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 41 82.000000 6640.3600 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 41 73.500000 5278.1100 5278.1100
T 0 0.000000 0.0000 0.0000
5 8.000000 542.5400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 46 81.500000 5820.6500 5278.1100