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: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 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 24 46.000000 3725.0800 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 11 20.000000 1619.6000 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 6 9.500000 769.3100 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 8.500000 688.3300 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 21 43.000000 2576.5600 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 8 14.000000 838.8800 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 8 15.000000 1214.7000 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 485 921.000000 73813.7600 80.1452
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 126 196.500000 15832.5700 80.5729
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 248 452.000000 36398.8800 80.5285
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 121 199.000000 16115.0200 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 137 264.500000 21095.2900 79.7553
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 59 107.500000 8705.3500 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 420 765.000000 45829.9600 59.9084
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 161 293.500000 17586.5200 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 105 196.500000 15831.5900 80.5679
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 80 143.500000 11620.6300 80.9800
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 7 7.000000 2128.0000 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) 1353 4245.186027 303990.9600 71.6084
-----------------------------------------------------------------------------------------------------------------------
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 3 2.000000 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
INTR-T1013-INTERPRETER 1 1.000000 50.0000 50.0000
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 77 384.489869 23606.4900 61.3969
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
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:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
PHY-97110TL-PT SESSION BY LICENSED PT 2 5.000000 406.6000 81.3200
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 715 3147.623954 248976.7820 79.0999
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) 2060 11255.11979 785282.7120 69.7712
-----------------------------------------------------------------------------------------------------------------------
Total 15571.305816 1092595.9320 70.1673
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 3191
-----------------------------------------------------------------------------------------------------------------------
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 2300 2352.250000 139680.5120 139680.5100
D 74 73.750000 4760.9300 0.0000
S 0 0.000000 0.0000 0.0000
H 134 224.250000 16518.0100 0.0000
T 441 448.500000 25695.3900 25466.1000
14 20.500000 1393.8200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2963 3119.250000 188048.6620 165146.6100
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 211 186.500000 17553.7600 17553.7400
6 6.000000 414.3400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 217 192.500000 17968.1000 17553.7400
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
76 83.000000 5908.7900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 76 83.000000 5908.7900 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
202 238.000000 20923.5300 0.0000
Other 22 22.000000 1555.2300 0.0000
---------------------------------------------------------
Total 228 264.000000 22600.5000 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 299 268.750000 18546.2800 18546.2800
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 308 277.750000 19227.6300 19227.6300
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
457 485.750000 33373.5700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 559 585.750000 40340.5900 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 551 581.250000 43436.2000 43202.1900
D 5 9.000000 729.1600 0.0000
S 0 0.000000 0.0000 0.0000
H 16 32.000000 2591.3600 0.0000
T 0 0.000000 0.0000 0.0000
124 219.750000 17082.4200 0.0000
Other 5 10.000000 809.8000 0.0000
---------------------------------------------------------
Total 701 852.000000 64648.9400 43202.1900
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 748 858.500000 65247.4000 65247.4000
D 8 9.000000 731.2000 0.0000
S 0 0.000000 0.0000 0.0000
H 37 58.000000 4214.7300 4214.7300
T 481 514.000000 39160.9300 39160.9300
149 188.500000 14391.0600 0.0000
Other 46 88.500000 6282.2100 0.0000
---------------------------------------------------------
Total 1469 1716.500000 130027.5300 108623.0600
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
2080 1814.750000 134493.2300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5108 3861.000000 282381.0100 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 57 59.250000 3491.0400 2185.9500
D 25 25.750000 2092.6300 0.0000
S 0 0.000000 0.0000 0.0000
H 64 70.750000 5519.3200 0.0000
T 964 1012.500000 58734.9000 51206.3200
253 319.750000 22496.6100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1363 1488.000000 92334.5000 53392.2700
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 102 109.760000 7810.7100 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
525 559.500000 43214.7300 0.0000
Other 2 2.000000 162.6400 0.0000
---------------------------------------------------------
Total 742 781.000000 60163.0800 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 135 137.810000 8737.1500 8737.1500
678 708.690000 48266.1100 0.0000
Other 3 3.000000 243.9600 0.0000
---------------------------------------------------------
Total 855 887.750000 59796.2600 8807.8700
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
523 585.805815 46127.6300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 851 909.805815 70853.6500 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 182 334.000000 24035.7400 24035.7400
T 38 38.000000 2610.9600 2610.9600
158 158.670561 10068.2000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 393 544.000001 37756.0500 27509.5700