Summary Report for FSPSAs Ending During the Report Period Center: 05
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 1186 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 27 28 22.474604 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 27 28 22.474604 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT COS Exit 6 7 6.500000 $325.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 4.011111 $324.8200 $80.9800
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 0.011111 $0.9000 $80.9000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $161.9600 $80.9800
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 1 1 2.000000 $161.9600 $80.9800
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 2.000000 $161.9600 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 6 6 9.000000 $539.2800 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 5 5 8.011111 $480.0300 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 35 35 68.500000 $5547.1300 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 16 17 34.000000 $2753.3200 $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 7 7 14.000000 $1133.7200 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 17 17 32.000000 $2591.3600 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 6 6 11.500000 $931.2700 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 20 21 41.500000 $2486.6800 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 47 47 93.500000 $5602.5200 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 4.000000 $323.9200 $80.9800
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 0.005556 $0.3300 $58.5700
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 0.444444 $25.8200 $58.1000
PSTH -97161 PT EVAL LOW COMPLEXITY 3 3 2.788889 $162.0600 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 4 4 1.777777 $103.3000 $58.1100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.372222 $21.6300 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 2 2 0.650000 $37.7700 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.188889 $10.9800 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 1.577778 $91.6900 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.427778 $24.8600 $58.1100
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Subtotal (Total Children Is Unduplicated) 113 197 345.766666 $24374.3300 $70.4900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 11 11 8.071080 $40355.5000 $5000.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 66 71 84.765077 $4238.2400 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 28 37 32.455555 $1622.7800 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 197 206 243.825406 $12191.3200 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 64 72 69.297623 $3464.9000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 50 54 46.766668 $2338.3400 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 51 54 52.555560 $2627.8000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 88 92 84.183335 $4209.1800 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 54 54 57.219846 $2861.0200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.900000 $47.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 90 91 95.056350 $4752.8300 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 76 80 71.700003 $3585.0200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 3.377779 $84.4500 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 5 5 9.533334 $257.4000 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 75 88 446.933333 $24134.4200 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 14 14 87.214287 $4709.5800 $54.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3 3 10.142857 $121.7100 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 7 10 44.857143 $3647.8000 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 1 1 3.714286 $302.0500 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 2.142857 $174.2600 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 0.714286 $58.0900 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 5 5 29.071428 $2364.0900 $81.3200
PHY -97110GP PT SESSION BY LICENSED PT 1 1 1.000000 $81.3200 $81.3200
PHY -97110TLGP PT SESSION BY LICENSED PT 1 1 7.571429 $615.7100 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 7.000000 $569.2400 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 4.857143 $394.9800 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 4.857143 $394.9800 $81.3200
TRAV -TRAVS Travel by mile 1 1 1.000000 $0.4500 $0.4500
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Subtotal (Total Children Is Unduplicated) 303 961 1511.783808 $120204.9200 $79.5100
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Total 1186 1880.025078 $144579.2500 $76.9000
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Number of Children (Unduplicated) With at Least One Authorization 413