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: 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 3118 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 62 63 56.023016 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 62 63 56.023016 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 8 9 5.432877 $263.5000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 6.000000 $370.2600 $61.7100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 2 2 7.571429 $175.2000 $23.1400
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
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Subtotal (Total Children Is Unduplicated) 164 191 216.162232 $12662.0900 $58.5800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.000000 $10000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 245 253 274.152447 $13707.6200 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 60 63 53.612102 $2680.5900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 36 36 32.828931 $820.7300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 128 142 256.147096 $12807.3600 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 17 19 30.333332 $1516.6600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 6 6 12.766667 $319.1700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 28 28 66.424605 $3321.2400 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 9 9 16.799999 $840.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 10.100000 $252.5000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 42 42 64.389956 $3219.5100 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 3 3 -0.100000 $-5.0000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 2.933333 $73.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 63 63 102.668252 $5133.4100 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 6 6 9.433333 $471.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 5 28.823809 $720.6000 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 9.000000 $450.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 24 24 181.923808 $9823.8900 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 7 7 38.714285 $2090.5700 $54.0000
INTR -T1013 INTERPRETER 204 281 427.266666 $21363.3400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 742 905 5606.937507 $67283.2800 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 4.400000 $357.8100 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 3 3 11.914286 $968.8600 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 6 6 -5.857143 $-476.3100 $81.3200
TRAV -TRAVS Travel by mile 761 954 5732.385125 $2550.9100 $0.4400
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Subtotal (Total Children Is Unduplicated) 916 2864 12969.998396 $160291.7200 $12.3600
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Total 3118 13242.183644 $172953.8100 $13.0600
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Number of Children (Unduplicated) With at Least One Authorization 1070