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:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 3 1.500000 68.5200 45.6800
TCM-T1017TL-TARGETED CASE MANAGEMENT 35 69.500000 3253.7400 46.8164
Subtotal (Total Children Is Unduplicated) 36 71.000000 3322.2600 46.7924
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 18 20.000000 386.2800 19.3140
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 18 20.000000 290.7000 14.5350
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 19 19.000000 161.2100 8.4847
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 18 20.000000 572.5800 28.6290
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 20 21.000000 478.8900 22.8043
AUDE-92650-AEP SCR AUDITORY POTENTIAL 1 1.000000 54.9000 54.9000
AUDE-92652-AEP THRSHLD EST MLT FREQ I&R 1 2.000000 141.4400 70.7200
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 45.3200 45.3200
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 2.000000 231.6200 115.8100
EXIT-EXIT-COS Exit 3 3.500000 175.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 15 29.500000 2388.9100 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 9 13.500000 1093.2300 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 7 12.500000 1012.2500 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 5 7.500000 607.3500 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 323.9200 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 3.500000 283.4300 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 16 33.000000 1977.3600 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 7 12.000000 719.0400 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 5 11.000000 890.7800 80.9800
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 4 5.000000 404.9000 80.9800
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 2 3.500000 194.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 335 660.000000 52758.9600 79.9378
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 93 146.000000 11743.0800 80.4321
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 168 312.000000 25061.6800 80.3259
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 92 149.500000 12106.5100 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 91 171.500000 13888.0700 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 46 84.000000 6802.3200 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 291 540.500000 32386.7600 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 104 191.500000 11474.6800 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 67 130.500000 10486.9100 80.3595
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 64 117.500000 9515.1500 80.9800
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 5 5.000000 1520.0000 304.0000
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 1 1.000000 193.0000 193.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 7 6.186027 359.4700 58.1100
OCTH-97165-OT EVAL LOW COMPLEXITY 22 22.000000 1212.2200 55.1009
OCTH-97166-OT EVAL MODERATE COMPLEXITY 11 13.000000 639.2100 49.1700
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 7 7.000000 406.7700 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 5 5.000000 290.5500 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 14 14.000000 813.5400 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 116.2200 58.1100
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
SCREEN-T1023-SCREENING 4 4.000000 215.9200 53.9800
SPCH-92521-EVAL OF SPEECH FLUENCY 20 22.000000 1229.9600 55.9073
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 21 21.000000 1220.3100 58.1100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 60 287.000000 16157.5700 56.2982
Subtotal (Total Children Is Unduplicated) 1004 3160.686027 223264.6600 70.6380
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 5.000000 4332.9000 866.5800
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 1 1.250000 62.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 1 1.000000 50.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 2 1.000000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 5 15.000000 405.0000 27.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 763 3538.250000 189973.2000 53.6913
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 67 173.500000 9369.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 1 1.000000 15.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 3 4.000000 48.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 344 1399.463479 109045.9700 77.9198
OCCT-97530GO-OT SESSION BY LICENSED OT 56 205.000000 16366.6400 79.8373
OCCT-97530GOGT-OT SESSION BY LICENSED OT 8 15.750000 1321.4500 83.9016
OCCT-97530GT-OT SESSION BY LICENSED OT 9 15.500000 1260.4600 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 76 378.489869 23215.7700 61.3379
OCCT-97530HMGT-OT SESSION BY OT ASST 6 13.345209 869.0400 65.1200
PHY-97110-PT SESSION BY LICENSED PT 456 1913.542794 150775.0100 78.7936
PHY-97110GP-PT SESSION BY LICENSED PT 1 1.000000 81.3200 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 12 11.250000 914.8500 81.3200
PHY-97110HM-PT SESSION BY PT ASST 44 203.404484 12987.3600 63.8499
PHY-97110HMGT-PT SESSION BY PT ASST 6 14.000000 911.6800 65.1200
PHY-97110TL-PT SESSION BY LICENSED PT 2 5.000000 406.6000 81.3200
CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2025 ending 12/31/2025 Date of Report:01/07/2026 Page: 2
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
SENS-V5050-IN EAR MONAURAL HEARING AID 1 2.000000 459.2200 229.6100
SENS-V5264-EARMOLD 2 4.000000 72.5200 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 714 3145.623954 248814.1420 79.0985
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 37 100.500000 8086.0400 80.4581
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 12 64.250000 4118.8400 64.1065
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 2 5.000000 325.6000 65.1200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 3.000000 243.9600 81.3200
SPL-92508HA-GROUP SPL SESSION PER CHILD 1 3.000000 47.2800 15.7600
Subtotal (Total Children Is Unduplicated) 2057 11245.11979 784679.3520 69.7795
-----------------------------------------------------------------------------------------------------------------------
Total 14476.805816 1011266.2720 69.8542
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 2840
-----------------------------------------------------------------------------------------------------------------------
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 2284 2326.750000 137962.4020 137962.4000
D 74 73.750000 4760.9300 0.0000
S 0 0.000000 0.0000 0.0000
H 100 168.250000 12509.6300 0.0000
T 440 446.500000 25575.5500 25346.2600
12 18.500000 1252.9200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2910 3033.750000 182061.4320 163308.6600
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 208 180.500000 17067.8800 17067.8600
6 6.000000 414.3400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 214 186.500000 17482.2200 17067.8600
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
72 75.000000 5260.9500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 72 75.000000 5260.9500 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 4 4.000000 121.7400 121.7400
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
146 172.000000 15132.8100 0.0000
Other 22 22.000000 1555.2300 0.0000
---------------------------------------------------------
Total 172 198.000000 16809.7800 121.7400
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 298 266.750000 18384.3200 18384.3200
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
9 9.000000 681.3500 681.3500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 307 275.750000 19065.6700 19065.6700
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 102 100.000000 6967.0200 6967.0200
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
428 450.750000 30760.4000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 530 550.750000 37727.4200 6967.0200
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 538 555.250000 41330.7200 41238.4500
D 2 3.000000 243.2800 0.0000
S 0 0.000000 0.0000 0.0000
H 14 28.000000 2267.4400 0.0000
T 0 0.000000 0.0000 0.0000
111 194.750000 15138.9000 0.0000
Other 5 10.000000 809.8000 0.0000
---------------------------------------------------------
Total 670 791.000000 59790.1400 41238.4500
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 708 786.000000 60239.1300 60239.1300
D 8 9.000000 731.2000 0.0000
S 0 0.000000 0.0000 0.0000
H 35 55.000000 4034.9700 4034.9700
T 445 454.500000 35058.6600 35058.6600
122 144.000000 11240.6300 0.0000
Other 26 51.500000 3707.1500 0.0000
---------------------------------------------------------
Total 1344 1500.000000 115011.7400 99332.7600
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 3023 2041.250000 147545.9800 147545.9800
D 0 0.000000 0.0000 0.0000
S 5 5.000000 341.8000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1894 1494.250000 110726.1200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4922 3540.500000 258613.9000 147545.9800
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 7 7.000000 378.0000 378.0000
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 2.000000 162.6400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9 9.000000 540.6400 378.0000
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 54 53.250000 3072.6400 1919.1900
D 25 25.750000 2092.6300 0.0000
S 0 0.000000 0.0000 0.0000
H 62 66.750000 5195.4000 0.0000
T 949 982.500000 56739.2600 49261.8400
239 291.750000 20397.6500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1329 1420.000000 87497.5800 51181.0300
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 14 9.240000 912.8100 816.8100
D 99 105.260000 7541.0700 0.0000
S 4 4.000000 325.2800 0.0000
H 88 89.500000 7222.3100 0.0000
T 7 7.000000 514.6000 514.6000
513 538.500000 41545.7400 0.0000
Other 2 2.000000 162.6400 0.0000
---------------------------------------------------------
Total 727 755.500000 58224.4500 1331.4100
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 1 0.860000 70.7200 70.7200
D 34 33.390000 2153.0400 0.0000
S 0 0.000000 0.0000 0.0000
H 4 4.000000 325.2800 0.0000
T 133 133.810000 8497.4700 8497.4700
661 675.690000 45741.1900 0.0000
Other 3 3.000000 243.9600 0.0000
---------------------------------------------------------
Total 836 850.750000 57031.6600 8568.1900
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 187 185.250000 14462.1800 14462.1800
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 141 138.750000 10263.8400 10263.8400
482 503.805815 39487.2700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 810 827.805815 64213.2900 24726.0200
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 12 10.329440 797.1900 862.8700
D 3 3.000000 243.9600 0.0000
S 0 0.000000 0.0000 0.0000
H 141 260.500000 18757.6300 18757.6300
T 38 38.000000 2610.9600 2610.9600
153 150.670561 9525.6600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 347 462.500001 31935.4000 22231.4600