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:MED
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 9687 29678.00000 1343209.7800 45.2594
Subtotal (Total Children Is Unduplicated) 9687 29678.00000 1343209.7800 45.2594
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Screening, Eval, and Assessment,Class #02
AACIS-92597-AAC INTIAL EVAL BY LICENSED SLP 1 1.000000 116.8300 116.8300
AACIS-92597TL-AAC INTIAL EVAL BY LICENSED SLP 2 2.000000 233.6600 116.8300
AUDE-92558-OTOACOUSTIC EMISSIONS (SCREENING) 2 2.000000 13.7400 6.8700
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 74 133.500000 10810.8300 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 17 23.500000 1903.0300 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 28 44.500000 3603.6100 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 8 13.500000 1093.2300 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 12 22.000000 1781.5600 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 4 7.500000 607.3500 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 74 132.000000 7909.4400 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 34 54.000000 3235.6800 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 19 38.500000 3117.7300 80.9800
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 5 8.500000 688.3300 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 755 1360.000000 110051.8200 80.9205
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 292 437.000000 35346.1400 80.8836
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 453 788.000000 63746.5700 80.8967
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 262 428.000000 34546.8700 80.7170
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 266 468.500000 37918.0700 80.9350
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 110 197.000000 15953.0600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 899 1588.000000 95142.4600 59.9134
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 492 800.500000 47906.0400 59.8451
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 191 324.500000 26126.2700 80.5124
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 113 183.000000 14900.3200 81.4225
OCTF-97168-OT RE-EVAL EST PLAN CARE 11 11.000000 639.2100 58.1100
OCTH-97165-OT EVAL LOW COMPLEXITY 18 18.000000 1045.9800 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 11 11.000000 639.2100 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-97161TL-PT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97163-PT EVAL HIGH COMPLEXITY 2 2.000000 116.2200 58.1100
PSTH-97163TL-PT EVAL HIGH COMPLEXITY 2 2.000000 116.2200 58.1100
SCREEN-T1023-SCREENING 17 17.000000 917.6600 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 4 4.000000 232.4400 58.1100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 3.000000 174.3300 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 22 138.000000 8019.1800 58.1100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 9 34.000000 1975.7400 58.1100
Subtotal (Total Children Is Unduplicated) 2328 7347.000000 533534.3300 72.6193
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EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 1 1.000000 47.9400 47.9400
AACFIT-92609TL-AAC FITTING, ADJUST, TRAINING VISIT 1 1.000000 47.9400 47.9400
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 14 22.000000 594.0000 27.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4774 28710.50000 1549474.4600 53.9689
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 513 1735.500000 93555.0000 53.9067
OCCT-97530-OT SESSION BY LICENSED OT 263 1167.750000 94880.1100 81.2504
OCCT-97530GO-OT SESSION BY LICENSED OT 14 26.000000 2114.3200 81.3200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 2 5.000000 406.6000 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 7 14.000000 975.8400 69.7029
OCCT-97530HM-OT SESSION BY OT ASST 95 499.750000 32608.5200 65.2497
OCCT-97530HMGT-OT SESSION BY OT ASST 3 9.000000 586.0800 65.1200
OCCT-97530TL-OT SESSION BY LICENSED OT 4 9.000000 731.8800 81.3200
OCCT-97530TLGO-OT SESSION BY LICENSED OT 127 411.250000 33442.8500 81.3200
OCCT-97530TLGOGT-OT SESSION BY LICENSED OT 16 15.500000 1260.4600 81.3200
OCCT-97530TLGTHM-OT SESSION BY OT ASST 6 9.000000 586.0800 65.1200
OCCT-97530TLHM-OT SESSION BY OT ASST 22 89.000000 5795.6800 65.1200
PHY-97110-PT SESSION BY LICENSED PT 257 965.250000 78494.1300 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 2 2.000000 162.6400 81.3200
PHY-97110HM-PT SESSION BY PT ASST 68 329.750000 21473.3200 65.1200
PHY-97110HMGT-PT SESSION BY PT ASST 3 10.000000 651.2000 65.1200
PHY-97110TL-PT SESSION BY LICENSED PT 120 450.750000 36654.9900 81.3200
PHY-97110TLGP-PT SESSION BY LICENSED PT 2 2.000000 162.6400 81.3200
PHY-97110TLGPGT-PT SESSION BY LICENSED PT 2 2.000000 162.6400 81.3200
PHY-97110TLGT-PT SESSION BY LICENSED PT 3 2.500000 203.3000 81.3200
PHY-97110TLHM-PT SESSION BY PT ASST 9 43.000000 2800.1600 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 380 1704.500000 138609.9400 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 20 44.750000 3639.0700 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 125 407.500000 33137.9000 81.3200
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 19 31.750000 2489.6000 78.4126
Subtotal (Total Children Is Unduplicated) 5941 36812.00000 2141675.2100 58.1787
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Total 73837.000000 4018419.3200 54.4228
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Number of Children (Unduplicated) With at Least One Service 11794
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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 142 155.750000 8893.6900 0.0000
S 344 258.500000 13589.9200 0.0000
H 718 788.500000 48722.9300 48722.9300
T 0 0.000000 0.0000 0.0000
8 7.500000 442.8800 0.0000
Other 7 5.250000 292.7700 0.0000
---------------------------------------------------------
Total 1219 1215.500000 71942.1900 48722.9300
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
1015 694.750000 33326.7600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1015 694.750000 33326.7600 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 113 204.250000 9344.3800 0.0000
U 0 0.000000 0.0000 0.0000
B 993 1643.250000 77901.9500 0.0000
P 543 876.250000 44127.4400 42009.8700
D 11 20.000000 1036.4100 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
250 296.250000 21384.7900 0.0000
Other 3 4.500000 216.5200 0.0000
---------------------------------------------------------
Total 6789 7920.250000 418766.2100 42009.8700
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.250000 11.4200 0.0000
U 0 0.000000 0.0000 0.0000
B 2747 1456.750000 66542.2200 31822.2000
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
18 10.500000 479.6400 0.0000
Other 57 42.000000 1918.5600 0.0000
---------------------------------------------------------
Total 2823 1509.500000 68951.8400 31822.2000
Center 06
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 2.000000 89.2400 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
9310 7909.250000 403917.4600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9313 7911.250000 404006.7000 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 65 50.750000 2318.2600 0.0000
U 0 0.000000 0.0000 0.0000
B 390 386.750000 21112.1600 0.0000
P 1477 1409.000000 75340.5600 73994.8800
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
21 17.500000 870.0000 0.0000
Other 60 49.750000 2512.8600 0.0000
---------------------------------------------------------
Total 2013 1913.750000 102153.8400 73994.8800
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 1173 1477.000000 74771.1700 74771.1700
T 0 0.000000 0.0000 0.0000
5326 5565.000000 311321.3900 0.0000
Other 73 139.000000 9290.3700 0.0000
---------------------------------------------------------
Total 6583 7192.000000 396004.2500 74771.1700
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 117 107.750000 5010.4900 0.0000
U 0 0.000000 0.0000 0.0000
B 7268 6881.250000 351539.2100 0.0000
P 29 48.250000 3431.4300 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
10281 8916.250000 536616.8300 0.0000
Other 802 586.500000 26738.3200 0.0000
---------------------------------------------------------
Total 18510 16551.500000 924098.3400 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
621 628.500000 42285.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 621 628.500000 42285.6000 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 23 15.250000 746.5400 0.0000
U 0 0.000000 0.0000 0.0000
B 903 945.000000 49050.2400 0.0000
P 755 843.250000 47831.6500 47517.2500
D 0 0.000000 0.0000 0.0000
S 215 196.000000 8871.8600 0.0000
H 0 0.000000 0.0000 0.0000
T 1 1.000000 54.0000 15.0000
892 951.000000 53443.8200 0.0000
Other 52 39.500000 1798.0000 0.0000
---------------------------------------------------------
Total 2841 2991.000000 161796.1100 47532.2500
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 141 120.000000 6361.3000 0.0000
U 0 0.000000 0.0000 0.0000
B 1714 1655.750000 96766.1300 37.2000
P 997 941.000000 56263.5400 55806.4200
D 129 109.500000 5156.7300 3844.6400
S 42 40.250000 2818.2100 0.0000
H 4 4.250000 265.4200 0.0000
T 0 0.000000 0.0000 0.0000
1287 1351.250000 76550.2400 0.0000
Other 215 150.250000 7065.2100 432.8200
---------------------------------------------------------
Total 4529 4372.250000 251246.7800 60121.0800
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 84 81.500000 4352.0200 0.0000
U 0 0.000000 0.0000 0.0000
B 2300 2196.750000 114038.8200 0.0000
P 1393 1314.750000 72050.1900 71255.2700
D 200 176.500000 8295.8000 6233.1400
S 129 111.000000 4956.0000 0.0000
H 4 3.750000 206.9400 0.0000
T 0 0.000000 0.0000 0.0000
1813 1928.750000 112594.5600 0.0000
Other 296 206.500000 9622.3800 1625.9400
---------------------------------------------------------
Total 6219 6019.500000 326116.7100 79114.3500
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3082 3048.250000 154192.7900 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
2400 2507.500000 164750.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5482 5555.750000 318943.3900 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 1931 3124.250000 158437.8700 158437.8700
T 0 0.000000 0.0000 0.0000
6149 6237.250000 340342.7300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8080 9361.500000 498780.6000 158437.8700