Summary Report for FSPSAs Initiated During the Report Period Center: 02
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
Eligibility Filter: Program Patients
With the filters selected there were 1931 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 3 3 9.063492 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 3 3 9.063492 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 32 32 20.780443 $1007.8600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 7 7 2.891629 $178.4400 $61.7100
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 2.000000 $32.3000 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 2.000000 $48.5600 $24.2800
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 1.366667 $61.9400 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 0.527778 $61.1200 $115.8100
EXIT -EXIT COS Exit 3 3 2.002740 $100.1400 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 4.005479 $324.3700 $80.9800
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 2.000000 $161.9600 $80.9800
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 4.000000 $323.9200 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 2.005479 $120.1700 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 2 2 4.000000 $239.6800 $59.9200
IPDEF -T1024TSTL F/U PSYCH AND DEV EVAL BY EI PROF 2 2 4.000000 $323.9200 $80.9800
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 81 83 127.104101 $10292.9200 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 23 23 45.000000 $3644.1000 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 58 61 119.500000 $9677.1100 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 14 14 28.000000 $2267.4400 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 121 131 222.604101 $13338.4600 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 46 47 93.000000 $5572.5600 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 85 111 220.000000 $17815.6000 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 32 48 96.000000 $7774.0800 $80.9800
OCTF -97168 OT RE-EVAL EST PLAN CARE 2 2 0.178082 $10.3500 $58.1200
OCTH -97165 OT EVAL LOW COMPLEXITY 40 41 30.687193 $1783.2500 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 9 9 6.450305 $374.8300 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 5 5 1.519407 $88.2900 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 34 34 21.362176 $1241.3700 $58.1100
PSTH -97161TL PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 7 7 4.570473 $265.5900 $58.1100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 3 3 1.388889 $80.7100 $58.1100
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 1 1 0.394444 $22.9200 $58.1000
SPCH -92521 EVAL OF SPEECH FLUENCY 48 48 31.566592 $1834.3500 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 0.272222 $15.8200 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 1.000000 $58.1100 $58.1100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 1.142857 $66.4100 $58.1100
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 0.246575 $14.3300 $58.1200
SPCH -92522GT EVAL OF SPCH SOUND PROD 3 3 1.783333 $103.6300 $58.1100
SPCH -92522TL EVAL OF SPCH SOUND PROD 2 2 1.167123 $67.8200 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 9 9 8.030137 $466.6300 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.316667 $18.4000 $58.1200
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.472222 $27.4400 $58.1100
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 0.638889 $37.1300 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 11.285714 $655.8100 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 0.116667 $6.7800 $58.1300
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Subtotal (Total Children Is Unduplicated) 336 759 1130.378384 $80780.9400 $71.4600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 33 33 57.468059 $287339.5000 $4999.9900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 70 72 91.831680 $4591.5800 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 16 17 22.438889 $1121.9500 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 192 217 312.104758 $15605.2200 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 4 4 9.066666 $453.3300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 2 2.666666 $66.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 115 118 170.757144 $8537.8600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 9 10 6.099998 $304.9900 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 1 1 2.633333 $131.6700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.033333 $0.8300 $24.9800
CONSF -CONSF CONSULT, SLP, FACE TO FACE 170 173 262.671430 $13133.5800 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 2 2 5.366666 $268.3300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 3.200000 $80.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 193 207 1154.809538 $62359.7200 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 29 29 184.500004 $9962.9900 $54.0000
INTR -T1013 INTERPRETER 26 38 75.464286 $3773.2200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3 3 3.000000 $36.0000 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 67 67 387.466669 $31508.8600 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 3 3 19.857143 $1614.7900 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 1 1 0.142857 $11.6200 $81.3400
PHY -97110 PT SESSION BY LICENSED PT 49 49 306.257145 $24904.8800 $81.3200
PHY -97110GPGT PT SESSION BY LICENSED PT 2 2 2.285714 $185.8800 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 3 3 22.142857 $1800.6500 $81.3200
PHY -97110HM PT SESSION BY PT ASST 2 2 30.142857 $1962.9100 $65.1200
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.377778 $86.7500 $229.6200
SENS -V5060 BEHIND EAR HEARING AID 1 1 0.150000 $34.4400 $229.6100
SENS -V5264 EARMOLD 2 2 1.283333 $23.2700 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 72 73 495.214292 $40270.8300 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 9 9 67.000000 $5448.4600 $81.3200
TRAV -TRAVS Travel by mile 13 26 1542.285714 $686.3200 $0.4500
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Subtotal (Total Children Is Unduplicated) 311 1169 5238.718809 $516307.0400 $98.5600
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Total 1931 6378.160685 $597087.9900 $93.6100
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Number of Children (Unduplicated) With at Least One Authorization 443