Summary Report for FSPSAs Ending During the Report Period Statewide
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
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 22709 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 338 344 2003.838896 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 74 75 11316.699999 $516946.8500 $45.6800
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Subtotal (Total Children Is Unduplicated) 412 419 13320.538895 $516946.8500 $38.8100
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 2 2 1.522222 $177.8400 $116.8300
AACIS -92597TL AAC INTIAL EVAL BY LICENSED SLP 2 2 2.000000 $233.6600 $116.8300
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 62 68 51.490335 $2497.2800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 32 35 20.338886 $1255.0900 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 39 40 47.389683 $719.8500 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 388 388 377.736759 $8106.2300 $21.4600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 2 1.766667 $46.0000 $26.0400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 372 372 368.936758 $5958.3300 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 49 49 44.930158 $1090.9000 $24.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 369 369 366.297870 $2901.0800 $7.9200
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 1.000000 $10.8800 $10.8800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 378 378 381.464536 $12134.3900 $31.8100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 1.766667 $87.6100 $49.5900
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 26 27 14.077777 $213.8400 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 396 397 396.185965 $9167.7400 $23.1400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 0.166667 $9.1500 $54.9100
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 7.714286 $603.6400 $78.2500
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 1 1 1.644444 $133.5900 $81.2400
AUDE -V5010 ASSESSMENT FOR HEARING AID 19 20 17.628573 $798.9400 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 11 13 11.888889 $1376.8500 $115.8100
EXIT -EXIT COS Exit 277 282 257.693999 $12884.7000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 16 24 45.664384 $3424.8300 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 40 40 58.799163 $4761.5500 $80.9800
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 15 15 20.920700 $1694.1700 $80.9800
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 9 9 15.011111 $1215.6000 $80.9800
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 3 3 6.000000 $485.8800 $80.9800
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 7 7 10.022222 $811.6000 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 41 41 70.364992 $4216.2600 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 20 20 27.197869 $1629.6900 $59.9200
IPDEF -T1024TSTL F/U PSYCH AND DEV EVAL BY EI PROF 23 32 56.021916 $4536.6600 $80.9800
IPDEF -T1024TSTLGT F/U PHYC AND DEV EVAL BY EI PROF 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 395 408 777.598622 $62969.9700 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 62 65 126.000000 $10203.4800 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 129 130 258.000000 $20892.8400 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 56 56 111.000000 $8988.7800 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 130 131 261.500000 $21176.2700 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 21 22 42.000000 $3401.1600 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 430 452 873.812908 $52358.8900 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 255 278 543.505479 $32566.8500 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 271 326 650.000000 $52637.0000 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 118 157 311.505479 $25225.7200 $80.9800
NUTR -97802 NUTRITIONAL EVAL, INITIAL 23 26 83.709521 $4185.4700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 6 6 32.999999 $1650.0100 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 50 57 19.505327 $1133.4500 $58.1100
OCTF -97168GT OT RE-EVAL EST PLAN CARE 1 1 0.027778 $1.6200 $58.1600
OCTH -97165 OT EVAL LOW COMPLEXITY 100 105 78.559750 $4565.0900 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 7 7 5.172223 $300.5600 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 23 23 18.062785 $1049.6300 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 5 5 3.233333 $187.8900 $58.1100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 0.055556 $3.2300 $58.1600
OCTH -97167 OT EVAL HIGH COMPLEXITY 85 92 59.927777 $3482.4000 $58.1100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 4 4 3.433333 $199.5100 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 23 24 6.572221 $381.9000 $58.1100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 0.327778 $19.0500 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 31 33 13.455555 $781.9000 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 48 50 36.786900 $2137.6900 $58.1100
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97161TL PT EVAL LOW COMPLEXITY 2 2 1.100000 $63.9200 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 11 11 10.266232 $596.5700 $58.1100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 2 2 1.083333 $62.9500 $58.1100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 2 2 0.400000 $23.2400 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 36 39 23.999999 $1394.6300 $58.1100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 2 2 1.338889 $77.8000 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 25 25 8.022223 $466.1800 $58.1100
SCREEN-T1023 SCREENING 10 10 10.000000 $539.8000 $53.9800
SPCH -92521 EVAL OF SPEECH FLUENCY 113 116 108.525102 $6306.3800 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 6 6 2.138889 $124.2900 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 29 31 9.050000 $525.9000 $58.1100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 0.205556 $11.9500 $58.1200
SPCH -92522 EVAL OF SPCH SOUND PROD 7 7 3.693760 $214.6500 $58.1100
SPCH -92522GT EVAL OF SPCH SOUND PROD 2 2 1.100000 $63.9200 $58.1100
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 0.104110 $6.0500 $58.1000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 147 151 92.721800 $5388.0800 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.183333 $10.6500 $58.1000
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 9 9 23.087616 $1341.6100 $58.1100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 5 2.883333 $167.5500 $58.1100
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 39 40 244.122219 $14185.9400 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 6 6 19.794444 $1150.2500 $58.1100
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Subtotal (Total Children Is Unduplicated) 2643 5573 7568.216660 $426684.6800 $56.3800
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 3 3 2.577778 $123.5800 $47.9400
AACFIT-92609TL AAC FITTING, ADJUST, TRAINING VISIT 1 1 0.333333 $15.9800 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 64 68 77.399781 $386999.0000 $5000.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 20 21 32.360319 $2244.1900 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 8 8 9.000000 $2084.5800 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 779 948 950.045327 $47502.3000 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 163 171 162.091167 $8104.5400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 126 137 135.764710 $3394.1200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1122 1241 2022.788467 $101139.4000 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 73 82 165.837304 $8291.8800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 89 96 89.038887 $2225.9700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 564 628 916.311114 $45815.5800 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 47 50 63.461116 $3173.0800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 29 50 51.083328 $1277.0700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 298 329 473.155969 $23657.8100 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 44 44 50.683336 $2534.1800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 16 24 24.333334 $608.3400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 767 789 1019.036853 $50951.7800 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 63 67 70.577779 $3528.9000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 92 100 104.016667 $2600.4200 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 2 2 40.000000 $1000.0000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 136 150 786.366661 $21231.9100 $27.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 3 4 6.642857 $332.1500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 5255 5632 34428.611399 $1859145.3900 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 249 266 1572.684120 $84924.9700 $54.0000
INTR -T1013 INTERPRETER 311 443 913.035713 $45651.8000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1606 1886 11297.647590 $135571.7600 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 523 552 2763.458729 $224724.5400 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 17 17 57.245239 $4655.1800 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 4 4 12.441270 $1011.7300 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 18.000000 $1463.7600 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 71 76 433.209523 $28210.6300 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 2 2 0.714285 $46.5200 $65.1200
OCCT -97530TL OT SESSION BY LICENSED OT 93 102 412.080156 $33510.3800 $81.3200
OCCT -97530TLGO OT SESSION BY LICENSED OT 46 46 151.926192 $12354.6400 $81.3200
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 0.071429 $5.8100 $81.2900
OCCT -97530TLHM OT SESSION BY OT ASST 12 13 39.786508 $2590.9000 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 431 459 2080.369062 $169175.6700 $81.3200
PHY -97110GP PT SESSION BY LICENSED PT 18 18 91.328571 $7426.8500 $81.3200
PHY -97110GPGT PT SESSION BY LICENSED PT 3 3 20.438096 $1662.0300 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 7 7 41.428570 $3368.9800 $81.3200
PHY -97110HM PT SESSION BY PT ASST 39 41 261.033331 $16998.4900 $65.1200
PHY -97110HMGT PT SESSION BY PT ASST 3 3 26.571429 $1730.3300 $65.1200
PHY -97110TL PT SESSION BY LICENSED PT 83 89 311.498412 $25331.0200 $81.3200
PHY -97110TLGP PT SESSION BY LICENSED PT 1 1 5.857143 $476.3000 $81.3200
PHY -97110TLGT PT SESSION BY LICENSED PT 2 2 14.000000 $1138.4800 $81.3200
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 1.133333 $260.2200 $229.6000
SENS -V5060 BEHIND EAR HEARING AID 7 8 9.000000 $2066.4900 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 2 0.755556 $346.9900 $459.2500
SENS -V5264 EARMOLD 17 20 26.247620 $475.8700 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 699 745 3673.754855 $298749.7200 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 20 20 84.131746 $6841.6000 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 8 8 49.571429 $3228.0900 $65.1200
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 3 3 17.500000 $1139.6000 $65.1200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 130 141 552.370636 $44918.7900 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 5 6 23.833333 $1938.1300 $81.3200
SPL -92507TLGTHM SPL THERAPY SESSION BY SLP ASST 1 1 3.285714 $213.9600 $65.1200
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 9.428571 $148.5900 $15.7600
TRAV -TRAVS Travel by mile 872 1082 6427.326167 $2860.1600 $0.4400
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Subtotal (Total Children Is Unduplicated) 6918 16717 73084.681814 $3743201.0700 $51.2200
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Total 22709 93973.437369 $4686832.6000 $49.8700
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Number of Children (Unduplicated) With at Least One Authorization 8214