Summary Report for FSPSAs Initiated During the Report Period Center: 01
This report shows the total number of units/fees for FSPSAs initiated during the report period.
(i.e., start date of service authorization occurs during the report period). This report does not
represent all FSPSAs that overlap the report period. Note that service authorization periods may
range from 1 to 12 months and may vary in intensity from child to child.
FSPSAs starting between: 04-01-25 and 06-30-25 Date of Report: 07-19-25 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 3397 FSPSA's found
Services Cpt Code Number of Number of Total Units Total Cost of Avg Fee
Children Records Authorized Auth Services Per Unit Auth
Service Coordination, Class # 01
SCONLY-SCONLY *SERVICE COORDINATION ONLY 59 62 54.396034 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 59 62 54.396034 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 13 13 11.232877 $544.7900 $48.5000
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 2.733333 $150.0600 $54.9000
EXIT -EXIT COS Exit 84 90 79.255480 $3962.7700 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 2 4.000000 $300.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $239.6800 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $239.6800 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $161.9600 $80.9800
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.000000 $58.1100 $58.1100
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Subtotal (Total Children Is Unduplicated) 101 115 114.221690 $6142.9300 $53.7800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 5 3.276712 $16383.5000 $4999.9800
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 229 248 251.839239 $12591.9700 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 63 69 61.696807 $3084.8300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 34 35 31.569407 $789.2400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 159 174 293.886512 $14694.3400 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 27 32 50.229367 $2511.4800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 11 11 14.899999 $372.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 43 44 62.683333 $3134.1700 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 10 10 17.933333 $896.6700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 3.366667 $84.1700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 54 56 90.188892 $4509.4600 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 10 10 16.783334 $839.1700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 6.200000 $155.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 75 80 148.203175 $7410.1600 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 7 7 13.700001 $685.0100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 4.666666 $116.6700 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 2 10.142858 $507.1400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 20 21 113.285718 $6117.4200 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 6 6 32.999999 $1782.0100 $54.0000
INTR -T1013 INTERPRETER 216 265 440.935716 $22046.7800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 834 1043 6165.280244 $73983.3200 $12.0000
PHY -97110 PT SESSION BY LICENSED PT 1 1 1.142857 $92.9400 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 1 1 2.714286 $220.7300 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 4 13.571429 $1103.6300 $81.3200
TRAV -TRAVS Travel by mile 853 1088 6215.965958 $2766.1100 $0.4500
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Subtotal (Total Children Is Unduplicated) 982 3220 14067.162509 $176878.3500 $12.5700
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Total 3397 14235.780233 $183021.2800 $12.8600
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Number of Children (Unduplicated) With at Least One Authorization 1083