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:EIP DEI DEIP
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
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 1 0.500000 25.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 13 25.500000 2064.9900 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 6 10.500000 850.2900 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 6.000000 485.8800 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 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 15 31.000000 1857.5200 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 4 9.000000 728.8200 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 297 576.500000 46684.9700 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 81 120.000000 9717.6000 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 128 233.000000 18826.2200 80.7992
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 73 113.000000 9150.7400 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 75 140.000000 11337.2000 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 35 62.500000 5061.2500 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 221 406.000000 24327.5200 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 68 121.000000 7250.3200 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 53 103.500000 8300.4500 80.1976
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 57 103.500000 8381.4300 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
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 174.3300 58.1100
SCREEN-T1023-SCREENING 1 1.000000 53.9800 53.9800
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 116.2200 58.1100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 11 44.000000 2362.1400 53.6850
Subtotal (Total Children Is Unduplicated) 728 2159.000000 162442.9000 75.2399
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 4.000000 297.6000 74.4000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 1 1.250000 62.5000 50.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 2 1.000000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 13.000000 351.0000 27.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 130 533.500000 28819.5000 54.0197
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 8 14.250000 769.5000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 49 111.500000 8844.5400 79.3232
OCCT-97530GO-OT SESSION BY LICENSED OT 30 113.500000 9007.1800 79.3584
OCCT-97530GOGT-OT SESSION BY LICENSED OT 5 10.750000 914.8500 85.1023
OCCT-97530GT-OT SESSION BY LICENSED OT 6 5.500000 447.2600 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 19 88.000000 5633.4400 64.0164
OCCT-97530HMGT-OT SESSION BY OT ASST 2 2.500000 162.8000 65.1200
PHY-97110-PT SESSION BY LICENSED PT 77 284.000000 22384.2300 78.8177
PHY-97110GT-PT SESSION BY LICENSED PT 3 2.000000 162.6400 81.3200
PHY-97110HM-PT SESSION BY PT ASST 1 2.000000 130.2400 65.1200
PHY-97110TL-PT SESSION BY LICENSED PT 2 5.000000 406.6000 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 108 399.000000 31718.4800 79.4949
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 16 30.750000 2500.5900 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 3.000000 243.9600 81.3200
Subtotal (Total Children Is Unduplicated) 379 1624.500000 112856.9100 69.4718
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Total 3854.500000 278622.0700 72.2849
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Number of Children (Unduplicated) With at Least One Service 1101
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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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 100 168.250000 12509.6300 0.0000
T 0 0.000000 0.0000 0.0000
12 18.500000 1252.9200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 112 186.750000 13762.5500 0.0000
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
1 1.000000 45.6800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1 1.000000 45.6800 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
145 171.000000 15074.7000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 145 171.000000 15074.7000 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 1.000000 27.0000 27.0000
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 1 1.000000 27.0000 27.0000
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
203 231.500000 16656.4500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 203 231.500000 16656.4500 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 2 3.000000 243.2800 151.0100
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 134 238.750000 18702.7000 151.0100
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 72 112.250000 7929.6000 7929.6000
D 1 2.000000 161.9600 0.0000
S 0 0.000000 0.0000 0.0000
H 35 55.000000 4034.9700 4034.9700
T 49 71.250000 4987.4800 4987.4800
18 32.000000 2254.4000 0.0000
Other 1 2.000000 119.8400 0.0000
---------------------------------------------------------
Total 176 274.500000 19488.2500 16952.0500
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
245 513.000000 38446.9200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 245 513.000000 38446.9200 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 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 508 506.000000 28574.9100 21097.4900
90 113.500000 7246.5700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 739 765.250000 46182.1500 23016.6800
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 0 0.000000 0.0000 0.0000
406 425.500000 32798.8000 0.0000
Other 2 2.000000 162.6400 0.0000
---------------------------------------------------------
Total 613 635.500000 48962.9100 816.8100
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 0 0.000000 0.0000 0.0000
316 327.000000 23024.0600 0.0000
Other 3 3.000000 243.9600 0.0000
---------------------------------------------------------
Total 358 368.250000 25817.0600 70.7200
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
137 202.000000 16336.9200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 137 202.000000 16336.9200 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 1 2.000000 119.8400 185.5200
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 141 260.500000 18757.6300 18757.6300
T 0 0.000000 0.0000 0.0000
2 3.500000 241.3100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 144 266.000000 19118.7800 18943.1500