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
Eligibility Filter: Program Patients
With the filters selected there were 7130 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 85 86 75.923015 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 85 86 75.923015 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 31 32 29.332877 $1422.6500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 5 5 13.233333 $816.6300 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 21 21 43.465078 $660.2300 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 1.000000 $21.4600 $21.4600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 3 3 3.000000 $78.1200 $26.0400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $16.1500 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 8 8 8.000000 $194.2400 $24.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 2.000000 $15.8400 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.000000 $31.8100 $31.8100
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 1.000000 $15.1900 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 8 8 13.571429 $314.0400 $23.1400
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 1.000000 $78.2500 $78.2500
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 1 1 0.277778 $22.5700 $81.2500
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.000000 $45.3200 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 0.409285 $47.4000 $115.8100
EXIT -EXIT COS Exit 194 199 170.441259 $8522.0600 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 8 15 30.000000 $2250.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 7 7 14.000000 $1133.7200 $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 -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 4.000000 $323.9200 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 16 16 32.000000 $1917.4400 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 5 5 10.000000 $599.2000 $59.9200
IPDEF -T1024TSTL F/U PSYCH AND DEV EVAL BY EI PROF 23 34 60.021916 $4860.5800 $80.9800
IPDEF -T1024TSTLGT F/U PHYC AND DEV EVAL BY EI PROF 2 3 6.000000 $485.8800 $80.9800
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 94 108 216.000000 $17491.6800 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 26 30 56.000000 $4534.8800 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 22 23 46.000000 $3725.0800 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 9 9 17.500000 $1417.1500 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 45 45 88.066667 $7131.6400 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 12 13 24.500000 $1984.0100 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 329 354 699.077625 $41888.7400 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 135 159 307.005479 $18395.7700 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 291 351 697.010958 $56443.9500 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 118 163 331.862622 $26874.2300 $80.9800
OCTH -97165 OT EVAL LOW COMPLEXITY 8 9 9.000000 $522.9900 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 2 2 2.000000 $116.2200 $58.1100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 2 2.000000 $116.2200 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 4 4 4.000000 $232.4400 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.233333 $3.5300 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 14 14 16.857143 $979.5700 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 1.000000 $58.1100 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $58.1100 $58.1100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 6 6 42.066667 $2444.4900 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 3 3 24.714286 $1436.1500 $58.1100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 922 1675 3042.647735 $210504.0800 $69.1800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 22 26 14.732420 $73663.5000 $5000.1000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 0.738889 $51.2400 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 4.000000 $926.4800 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 354 391 422.524414 $21126.2200 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 93 104 81.394981 $4069.7200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 45 45 42.278931 $1056.9800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 203 232 406.032812 $20301.6600 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 23 27 43.933333 $2196.6700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 7 7 13.700000 $342.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 53 54 149.534129 $7476.7200 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 10 10 17.766666 $888.3300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 11.033333 $275.8300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 79 80 129.673290 $6483.6800 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 7 8 12.233333 $611.6700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 2.933333 $73.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 113 115 236.275395 $11813.7700 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 9 10 16.233333 $811.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 8 34.057143 $851.4300 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 5 5 26.790476 $1339.5200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 825 880 5996.447546 $323808.3500 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 137 144 959.857128 $51832.3200 $54.0000
INTR -T1013 INTERPRETER 237 323 496.588094 $24829.4200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1022 1308 8043.842241 $96526.1500 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 28 28 135.528572 $11021.1900 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 1 1 2.933333 $238.5400 $81.3200
OCCT -97530TLGTHM OT SESSION BY OT ASST 1 1 12.142857 $790.7500 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 69 73 458.638090 $37296.4500 $81.3200
PHY -97110GP PT SESSION BY LICENSED PT 2 2 13.142857 $1068.7800 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 3 3 30.114286 $2448.8900 $81.3200
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 9.285714 $755.1100 $81.3200
SENS -V5060 BEHIND EAR HEARING AID 2 2 2.277778 $523.0100 $229.6100
SENS -V5264 EARMOLD 5 5 5.004871 $90.7400 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 79 80 401.142850 $32620.9700 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 8 8 33.780953 $2747.0600 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 9.285714 $755.1100 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 2.714286 $220.7300 $81.3200
SPL -92508HA GROUP SPL SESSION PER CHILD 2 2 8.428571 $132.8300 $15.7600
TRAV -TRAVS Travel by mile 1046 1373 8187.447002 $3643.4100 $0.4400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1253 5369 26474.468954 $745710.6900 $28.1700
-------------------------------------------------------------------------------------------------------------------------------------
Total 7130 29593.039704 $956214.7600 $32.3100
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1629