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: 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 1610 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 8 8 23.602383 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 8 8 23.602383 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 16 16 14.964536 $725.7800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 6 6 3.627778 $223.8700 $61.7100
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.041096 $0.6600 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 3.000000 $72.8400 $24.2800
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 1.566667 $71.0000 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.471233 $54.5700 $115.8000
EXIT -EXIT COS Exit 13 13 10.974962 $548.7500 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 2 3.500000 $262.5000 $75.0000
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 4 4 8.000000 $479.3600 $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 7 8 16.000000 $1295.6800 $80.9800
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 61 62 84.109580 $6811.2300 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 10 10 19.500000 $1579.1100 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 44 44 86.000000 $6964.2800 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 20 20 40.000000 $3239.2000 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 143 155 268.109580 $16065.1500 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 48 50 99.000000 $5932.0800 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 93 109 217.500000 $17613.1500 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 25 31 62.000000 $5020.7600 $80.9800
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 1.000000 $58.1100 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 27 27 27.421429 $1593.4600 $58.1100
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 8 8 3.147261 $182.8800 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 2 2 0.611111 $35.5100 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 1.000000 $58.1100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 17 17 13.316666 $773.8300 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 6 6 1.874810 $108.9400 $58.1100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 2 2 0.550000 $31.9600 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 23 23 14.193075 $824.7600 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 0.233333 $13.5600 $58.1000
SPCH -92522 EVAL OF SPCH SOUND PROD 3 3 1.238356 $71.9600 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 3.166667 $184.0200 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 0.461263 $26.8000 $58.1000
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.461111 $26.7900 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 2 2 21.714286 $1261.8100 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 0.150000 $8.7200 $58.1100
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Subtotal (Total Children Is Unduplicated) 309 646 1041.904800 $73166.8200 $70.2200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 14 14 18.956317 $94781.5000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 52 54 59.622720 $2981.1300 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 14 16 20.500000 $1025.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 2.136073 $53.4000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 187 200 317.476195 $15873.8300 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 2 2 2.766667 $138.3400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 92 95 140.033333 $7001.6700 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 1 1 0.750000 $37.5000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 5.133334 $128.3400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 17 17 22.400002 $1120.0100 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 2 2 4.466667 $223.3400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 8 8 9.866668 $246.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 154 154 234.762701 $11738.1600 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 2.766667 $138.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 4.633334 $115.8400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 180 183 1161.719029 $62732.8700 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 36 37 251.357142 $13573.2800 $54.0000
INTR -T1013 INTERPRETER 25 40 86.500000 $4325.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 41 41 147.642854 $12006.3000 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 2 2 8.428572 $685.4100 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 1 1 3.071429 $249.7700 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 0.285714 $23.2300 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 0.122222 $9.9400 $81.3100
PHY -97110 PT SESSION BY LICENSED PT 25 25 162.714284 $13231.9300 $81.3200
PHY -97110GP PT SESSION BY LICENSED PT 1 1 6.142857 $499.5400 $81.3200
PHY -97110GPGT PT SESSION BY LICENSED PT 2 2 10.428571 $848.0500 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 2 2 27.571429 $2242.1100 $81.3200
PHY -97110HM PT SESSION BY PT ASST 1 1 10.000000 $651.2000 $65.1200
SENS -V5060 BEHIND EAR HEARING AID 1 1 2.000000 $459.2200 $229.6100
SENS -V5264 EARMOLD 1 1 0.706849 $12.8100 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 35 35 172.999997 $14068.3700 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 13.428571 $1092.0100 $81.3200
TRAV -TRAVS Travel by mile 5 10 600.000000 $267.0000 $0.4500
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Subtotal (Total Children Is Unduplicated) 279 956 3511.390198 $262581.0700 $74.7800
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Total 1610 4576.897381 $335747.8900 $73.3600
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Number of Children (Unduplicated) With at Least One Authorization 425