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
Agency Filter:EXT
Payclass Filters:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 84 148.000000 6754.2800 45.6370
Subtotal (Total Children Is Unduplicated) 84 148.000000 6754.2800 45.6370
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 7.000000 566.8600 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 13 24.500000 1468.0400 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 7.500000 449.4000 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 121.4700 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 36 69.000000 5587.6200 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 11 20.000000 1577.4800 78.8740
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 53 101.500000 8219.4700 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 44 83.000000 6689.7500 80.5994
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 33 66.000000 5344.6800 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 11 21.500000 1741.0700 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 115 220.000000 13182.4000 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 86 160.500000 9617.1600 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 16 27.500000 2226.9500 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 14 27.500000 2307.9300 83.9247
OCTF-97168-OT RE-EVAL EST PLAN CARE 11 11.000000 639.2100 58.1100
OCTH-97165-OT EVAL LOW COMPLEXITY 17 17.000000 987.8700 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 10 10.000000 581.1000 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 10 10.000000 581.1000 58.1100
OCTH-97167TL-OT EVAL HIGH COMPLEXITY 4 4.000000 232.4400 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 4 4.000000 232.4400 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 15 15.000000 871.6500 58.1100
PSTH-97163-PT EVAL HIGH COMPLEXITY 2 2.000000 116.2200 58.1100
PSTH-97163TL-PT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
SCREEN-T1023-SCREENING 2 2.000000 107.9600 53.9800
SPCH-92521-EVAL OF SPEECH FLUENCY 15 16.000000 929.7600 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 174.3300 58.1100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 21 137.000000 7961.0700 58.1100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 3 3.000000 174.3300 58.1100
Subtotal (Total Children Is Unduplicated) 474 1077.000000 73129.9000 67.9015
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 8 13.000000 351.0000 27.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4438 27344.00000 1475589.0000 53.9639
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 488 1695.500000 91395.0000 53.9045
OCCT-97530-OT SESSION BY LICENSED OT 252 1156.750000 93985.5900 81.2497
OCCT-97530GO-OT SESSION BY LICENSED OT 12 24.000000 1951.6800 81.3200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 2 5.000000 406.6000 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 6 12.000000 813.2000 67.7667
OCCT-97530HM-OT SESSION BY OT ASST 94 498.750000 32543.4000 65.2499
OCCT-97530HMGT-OT SESSION BY OT ASST 3 9.000000 586.0800 65.1200
OCCT-97530TL-OT SESSION BY LICENSED OT 1 6.000000 487.9200 81.3200
OCCT-97530TLGO-OT SESSION BY LICENSED OT 6 13.000000 1057.1600 81.3200
PHY-97110-PT SESSION BY LICENSED PT 249 957.250000 77843.5700 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 81.3200 81.3200
PHY-97110HM-PT SESSION BY PT ASST 67 328.250000 21375.6400 65.1200
PHY-97110HMGT-PT SESSION BY PT ASST 3 10.000000 651.2000 65.1200
PHY-97110TL-PT SESSION BY LICENSED PT 11 31.000000 2520.9200 81.3200
PHY-97110TLHM-PT SESSION BY PT ASST 7 36.000000 2344.3200 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 352 1654.000000 134503.2800 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 15 40.500000 3293.4600 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 19 91.000000 5925.9200 65.1200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 18 48.750000 3964.3500 81.3200
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 162.6400 81.3200
Subtotal (Total Children Is Unduplicated) 5352 33976.75000 1951833.2500 57.4461
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Total 35201.750000 2031717.4300 57.7164
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Number of Children (Unduplicated) With at Least One Service 5693
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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 139 150.750000 8594.0900 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 1.000000 54.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 140 151.750000 8648.0900 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 23 24.500000 1119.1600 0.0000
U 0 0.000000 0.0000 0.0000
B 94 101.250000 4625.1000 0.0000
P 16 18.750000 975.8500 673.7800
D 1 0.750000 27.9000 0.0000
S 0 0.000000 0.0000 0.0000
H 4876 4875.750000 264754.7200 0.0000
T 0 0.000000 0.0000 0.0000
4 3.500000 197.1700 0.0000
Other 1 1.000000 65.1200 0.0000
---------------------------------------------------------
Total 5015 5025.500000 271765.0200 673.7800
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
3855 3875.500000 209466.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3855 3875.500000 209466.0000 0.0000
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 11 11.000000 621.3200 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
4391 4449.000000 257066.7000 0.0000
Other 57 110.000000 7380.9500 0.0000
---------------------------------------------------------
Total 4459 4570.000000 265068.9700 0.0000
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.750000 34.2600 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 13 11.500000 762.0600 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
9963 8741.500000 528725.4100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9977 8753.750000 529521.7300 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
613 617.500000 41394.8200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 613 617.500000 41394.8200 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 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
694 700.250000 41340.3100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 694 700.250000 41340.3100 0.0000
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 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
1266 1321.000000 74604.5900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1266 1321.000000 74604.5900 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 0 0.000000 0.0000 0.0000
1774 1860.000000 107815.2300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1774 1860.000000 107815.2300 0.0000
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
2227 2295.500000 152325.4800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2227 2295.500000 152325.4800 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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6021 6031.000000 329767.1900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6021 6031.000000 329767.1900 0.0000