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:GR
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 8192 8392.750000 369263.0300 43.9979
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 706 657.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 7746 22682.75000 1024469.0200 45.1651
Subtotal (Total Children Is Unduplicated) 12644 31732.75000 1393732.0500 43.9209
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 22 25.000000 1212.5000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 12 12.000000 257.5200 21.4600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 13 13.000000 209.9500 16.1500
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 14 14.000000 110.8800 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 12 12.000000 381.7200 31.8100
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 1.000000 49.5900 49.5900
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 15.1900 15.1900
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 11 11.000000 254.5400 23.1400
EXIT-EXIT-COS Exit 519 636.250000 32012.5000 50.3143
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 17 34.000000 2712.8300 79.7891
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 8 15.500000 1093.2300 70.5310
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 11 20.500000 1660.0900 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 5.000000 404.9000 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 323.9200 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 42 77.000000 4613.8400 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 25 39.500000 2366.8400 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 6 10.500000 809.8000 77.1238
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 5 9.500000 769.3100 80.9800
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 3 5.500000 305.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 235 434.500000 34923.6200 80.3766
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 94 154.000000 12281.1500 79.7477
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 166 301.500000 24131.3600 80.0377
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 58 103.000000 8341.6200 80.9866
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 115 205.500000 16600.9000 80.7830
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 38 62.000000 5020.7600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 411 759.500000 45449.3200 59.8411
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 270 467.500000 28012.6000 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 84 157.000000 12594.0200 80.2167
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 35 63.000000 4866.5900 77.2475
NUTR-97802-NUTRITIONAL EVAL, INITIAL 22 73.000000 3650.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 13 47.000000 2350.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 7 6.813973 395.9600 58.1100
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 116.2200 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 116.2200 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 5 5.000000 290.5500 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 4 4.000000 191.3400 47.8350
PSTH-97161-PT EVAL LOW COMPLEXITY 9 9.000000 522.9900 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 116.2200 58.1100
SCREEN-T1023-SCREENING 6 6.000000 323.8800 53.9800
SPCH-92521-EVAL OF SPEECH FLUENCY 9 9.000000 490.8500 54.5389
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 13 13.000000 755.4300 58.1100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 116.2200 58.1100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 2 2.000000 68.4700 34.2350
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 29 174.000000 9852.5600 56.6239
Subtotal (Total Children Is Unduplicated) 1743 4010.563973 261143.2500 65.1138
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 34 66.000000 4697.3300 71.1717
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 534 636.750000 31815.5000 49.9654
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 921 956.750000 47716.5000 49.8735
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 148 146.500000 3704.1600 25.2844
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 444 503.250000 25143.4000 49.9620
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 744 914.750000 45783.0000 50.0497
CONIP-CONIP-CONSULT, ITDS PHONE 69 53.000000 1325.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 186 224.250000 11162.5000 49.7770
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 414 372.000000 18600.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 54 79.250000 2006.2500 25.3155
CONPF-CONPF-CONSULT, PT, FACE TO FACE 125 153.000000 7650.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 380 268.250000 13412.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 25 11.750000 293.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 298 319.750000 15975.0000 49.9609
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 666 643.000000 32150.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 56 39.000000 975.0000 25.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 1182 2970.250000 111.3200 0.0375
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 15 44.000000 1188.0000 27.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 9 9.000000 419.0000 46.5556
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3702 20078.44111 1081726.4600 53.8750
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 418 1205.500000 63824.6800 52.9446
EPIC-99601-Early Steps Professional Development Fee 8371 46952.00000 703028.0100 14.9733
INTR-T1013-INTERPRETER 282 816.750000 43200.7800 52.8935
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 6318 35829.00000 429508.6900 11.9877
OCCT-97530-OT SESSION BY LICENSED OT 268 963.286522 76129.2300 79.0307
OCCT-97530GO-OT SESSION BY LICENSED OT 35 135.250000 10998.5300 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:GR
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
OCCT-97530GOGT-OT SESSION BY LICENSED OT 7 17.000000 1297.0800 76.2988
OCCT-97530GT-OT SESSION BY LICENSED OT 11 26.000000 1903.0800 73.1954
OCCT-97530HM-OT SESSION BY OT ASST 70 310.510131 19891.0400 64.0592
OCCT-97530HMGT-OT SESSION BY OT ASST 5 9.404791 577.6800 61.4240
OCCT-97530TL-OT SESSION BY LICENSED OT 1 2.000000 162.6400 81.3200
OCCT-97530TLGO-OT SESSION BY LICENSED OT 3 5.000000 406.6000 81.3200
OCCT-97530TLGOGT-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
PHY-97110-PT SESSION BY LICENSED PT 296 1092.207206 87133.6200 79.7776
PHY-97110GP-PT SESSION BY LICENSED PT 1 1.000000 81.3200 81.3200
PHY-97110GPGT-PT SESSION BY LICENSED PT 1 1.000000 81.3200 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 9 23.000000 1849.0400 80.3930
PHY-97110HM-PT SESSION BY PT ASST 26 122.595516 7983.4200 65.1200
PHY-97110HMGT-PT SESSION BY PT ASST 1 6.000000 390.7200 65.1200
PHY-97110TL-PT SESSION BY LICENSED PT 3 4.000000 325.2800 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 446 1721.376046 135657.9400 78.8078
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 19 50.250000 3842.3700 76.4651
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 7 26.000000 1584.6300 60.9473
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 2 4.000000 325.2800 81.3200
TRAV-TRAVS-Travel by mile 3684 252062.0000 112000.4600 0.4443
Subtotal (Total Children Is Unduplicated) 14855 369875.0713 3048119.4300 8.2409
-----------------------------------------------------------------------------------------------------------------------
Total 405618.385296 4702994.7300 11.5946
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 21078
-----------------------------------------------------------------------------------------------------------------------
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 12085 38097.500000 210599.6500 210599.6500
D 264 383.750000 6068.2100 0.0000
S 0 0.000000 0.0000 0.0000
H 1 1.000000 81.3200 0.0000
T 2605 7389.000000 46094.7500 46145.2000
605 461.750000 23279.7400 54.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15560 46333.000000 286123.6700 256798.8500
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 3372 9136.750000 95928.4900 95815.3200
47 47.000000 1091.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3419 9183.750000 97019.4900 95815.3200
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
4824 31587.000000 115088.9300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4824 31587.000000 115088.9300 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 8156 8117.750000 183405.1500 183363.1500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 36 36.000000 1818.0000 0.0000
T 0 0.000000 0.0000 0.0000
1339 1520.750000 71376.8900 0.0000
Other 1 1.000000 15.0000 15.0000
---------------------------------------------------------
Total 9532 9675.500000 256615.0400 183378.1500
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 7492 52794.250000 159762.1700 159762.1700
D 14 4.750000 216.9800 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
4111 5724.000000 81913.7700 9933.4500
Other 13 5.250000 228.3000 -0.1000
---------------------------------------------------------
Total 11630 58528.250000 242121.2200 169695.5200
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 4665 4720.000000 127501.9400 127501.9400
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
9064 7064.250000 260646.3200 0.0000
Other 187 100.250000 4526.4200 0.0000
---------------------------------------------------------
Total 13916 11884.500000 392674.6800 127501.9400
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 12656 15785.500000 337647.9900 337647.9900
D 20 15.250000 652.1000 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
5422 3308.250000 139239.8600 0.0000
Other 8 4.000000 228.3600 -162.0000
---------------------------------------------------------
Total 18106 19113.000000 477768.3100 337485.9900
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 10674 35736.750000 331878.1000 331878.1000
D 96 252.000000 4912.1200 0.0000
S 1 1.000000 54.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 4720 9633.250000 170706.3400 170706.3400
2677 10650.000000 82243.5700 11.4200
Other 16 32.000000 2212.2800 0.0000
---------------------------------------------------------
Total 18184 56305.000000 592006.4100 502595.8600
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 17674 17299.000000 436494.6200 436494.6200
D 2 2.000000 162.6400 0.0000
S 20 19.500000 519.0000 200.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5011 4301.750000 200422.5900 0.0000
Other 46 39.500000 1804.3600 0.0000
---------------------------------------------------------
Total 22753 21661.750000 639403.2100 436694.6200
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 1695 2682.500000 96183.1500 96183.1500
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 80.9800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1696 2683.500000 96264.1300 96183.1500
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 3 1.500000 68.5200 0.0000
H 0 0.000000 0.0000 0.0000
T 4964 27747.500000 72732.6700 71150.6720
2884 1883.750000 79021.4800 49.1200
Other 14 12.250000 559.5800 0.0000
---------------------------------------------------------
Total 7865 29645.000000 152382.2500 71199.7920
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 75 64.250000 4221.5200 0.0000
S 8 8.000000 493.0100 0.0000
H 0 0.000000 0.0000 0.0000
T 1153 7115.750000 20828.4300 19531.5500
11551 23052.250000 211820.4700 130.2000
Other 27 16.500000 1087.2900 0.0000
---------------------------------------------------------
Total 12814 30256.750000 238450.7200 19661.7500
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 78 69.750000 3627.3000 0.0000
S 54 23.000000 871.8800 0.0000
H 0 0.000000 0.0000 0.0000
T 2017 14342.250000 36496.8000 36496.8000
12374 35386.500000 265729.6300 0.0000
Other 35 17.750000 879.3000 161.9600
---------------------------------------------------------
Total 14558 49839.250000 307604.9100 36658.7600
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 3105 3089.971955 88942.3100 88942.3100
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 1608 1603.206135 43174.2700 43174.2700
6092 4933.707206 206315.2600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10805 9626.885296 338431.8400 132116.5800
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 142 136.250000 3970.8400 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 7224 9011.500000 186872.6500 186872.6500
8436 10147.500000 280196.4300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15802 19295.250000 471039.9200 186872.6500