Summary Report for FSPSAs Ending During the Report Period Center: 01
This report shows the total number of units/fees for FSPSAs ending during the report period.
(i.e., end 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 ending between: 10-01-25 and 12-31-25 Date of Report: 01-07-26 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 3458 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 72 73 59.638890 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 72 73 59.638890 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 15 16 12.780822 $619.8600 $48.5000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 6.571429 $152.0600 $23.1400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 0.166667 $9.1500 $54.9100
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 1 1 1.644444 $133.5900 $81.2400
EXIT -EXIT COS Exit 137 140 119.157926 $5957.9000 $50.0000
IPDEF -T1024TSTL F/U PSYCH AND DEV EVAL BY EI PROF 1 2 4.000000 $323.9200 $80.9800
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 2 2 4.000000 $323.9200 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 2 2 4.000000 $323.9200 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 1 2 4.000000 $323.9200 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 7 7 14.000000 $838.8800 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 3 3 6.000000 $359.5200 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 4 5 10.000000 $809.8000 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 8 13 26.000000 $2105.4800 $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) 170 199 219.321288 $12825.9100 $58.4800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 3.000000 $15000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 244 251 271.652447 $13582.6200 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 60 63 53.012102 $2650.5900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 35 37 32.995597 $824.8900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 160 176 313.616665 $15680.8300 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 28 34 115.877779 $5793.9000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 6 6 11.633333 $290.8300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 48 48 79.833333 $3991.6700 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 8 8 15.666667 $783.3400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 6.400000 $160.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 57 57 101.400004 $5070.0200 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 8 8 9.366667 $468.3400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 5.066666 $126.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 67 68 118.189681 $5909.4800 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 8 8 10.833332 $541.6600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 5.900000 $147.5000 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 4.142857 $207.1500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 38 38 283.471428 $15307.4600 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 7 8 43.019048 $2323.0400 $54.0000
INTR -T1013 INTERPRETER 208 283 449.633331 $22481.6700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 808 1007 5765.439659 $69185.2700 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 11.438096 $930.1500 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 3 3 42.647619 $3468.1000 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 1 1 10.285714 $836.4300 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 5 5 53.142856 $4321.5800 $81.3200
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 9.428571 $148.5900 $15.7600
TRAV -TRAVS Travel by mile 857 1061 5865.111882 $2609.9700 $0.4400
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Subtotal (Total Children Is Unduplicated) 1049 3186 13692.205334 $192841.7200 $14.0800
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Total 3458 13971.165512 $205667.6400 $14.7200
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Number of Children (Unduplicated) With at Least One Authorization 1143