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
Eligibility Filter: Program Patients
With the filters selected there were 5018 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 81 82 74.365874 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 81 82 74.365874 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 28 29 22.468190 $1089.7000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 2.000000 $123.4200 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 2.000000 $30.3800 $15.1900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.000000 $24.2800 $24.2800
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 2 2 1.877777 $152.5400 $81.2400
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 2.000000 $90.6400 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 1.233333 $142.8300 $115.8100
EXIT -EXIT COS Exit 174 179 154.907926 $7745.4000 $50.0000
IPDEF -T1024TSTL F/U PSYCH AND DEV EVAL BY EI PROF 1 2 4.000000 $323.9200 $80.9800
IPDEF -T1024TSTLGT F/U PHYC 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 2 2 3.500000 $283.4300 $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 3 3 6.000000 $485.8800 $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 20 21 42.000000 $2516.6400 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 7 8 16.000000 $958.7200 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 16 20 41.000000 $3320.1800 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 12 17 33.500000 $2712.8300 $80.9800
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 2.000000 $116.2200 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 4 4 4.000000 $232.4400 $58.1100
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 2 2.000000 $116.2200 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 4.000000 $232.4400 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 10.428571 $606.0100 $58.1100
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Subtotal (Total Children Is Unduplicated) 252 314 382.653893 $22993.4500 $60.0900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 11 11 8.457535 $42287.5000 $4999.9800
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 352 388 428.057747 $21402.8900 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 91 102 80.289502 $4014.4500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 43 45 41.245597 $1031.1400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 236 265 454.253174 $22712.6600 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 36 45 129.077779 $6453.9000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 6 6 11.633333 $290.8300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 76 78 132.388891 $6619.4600 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 9 9 17.333334 $866.6700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 6.400000 $160.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 101 103 194.133337 $9706.6900 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 15 16 24.380952 $1219.0500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 5.066666 $126.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 117 119 227.016664 $11350.8200 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 14 14 22.833331 $1141.6600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 9 9 17.877778 $446.9500 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 3 3 19.428571 $971.4400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 74 77 511.480950 $27619.9900 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 18 19 110.647620 $5974.9800 $54.0000
INTR -T1013 INTERPRETER 222 299 472.766664 $23638.3400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1115 1447 8152.224564 $97826.7100 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 5 5 26.152382 $2126.7100 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 1 1 2.933333 $238.5400 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 1 1 8.000000 $520.9600 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 14 14 95.752381 $7786.5900 $81.3200
PHY -97110GPGT PT SESSION BY LICENSED PT 1 1 8.000000 $650.5600 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 1 1 10.285714 $836.4300 $81.3200
SENS -V5060 BEHIND EAR HEARING AID 2 2 1.233333 $283.1800 $229.6000
SENS -V5264 EARMOLD 2 2 2.233333 $40.4900 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 16 17 116.999999 $9514.4500 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 1.857143 $151.0200 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 3.428571 $223.2700 $65.1200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 10.428571 $848.0500 $81.3200
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 9.428571 $148.5900 $15.7600
TRAV -TRAVS Travel by mile 1175 1513 8250.304725 $3671.3800 $0.4400
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Subtotal (Total Children Is Unduplicated) 1395 4622 19614.032045 $312902.9800 $15.9500
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Total 5018 20071.051812 $335896.4300 $16.7400
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Number of Children (Unduplicated) With at Least One Authorization 1522