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 9477 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 310 315 1971.905562 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 4 4 761.666667 $34792.9300 $45.6800
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Subtotal (Total Children Is Unduplicated) 314 319 2733.572229 $34792.9300 $12.7300
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 2 2 1.522222 $177.8400 $116.8300
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 59 65 50.366971 $2442.7900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 4 5 2.322222 $143.3000 $61.7100
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 17 17 17.000000 $364.8200 $21.4600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 16 16 16.000000 $258.4000 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 5 5 4.194444 $101.8400 $24.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 16 16 16.000000 $126.7200 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 16 16 16.000000 $508.9600 $31.8100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 1.000000 $49.5900 $49.5900
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 1.111111 $16.8800 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 19 19 22.832540 $528.3400 $23.1400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 0.166667 $9.1500 $54.9100
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 1 1 1.644444 $133.5900 $81.2400
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 2.072223 $93.9200 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 5 2.888889 $334.5600 $115.8100
EXIT -EXIT COS Exit 271 276 253.660666 $12683.0300 $50.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 2 2 2.011111 $162.8600 $80.9800
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $161.9600 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 4 4 6.000000 $359.5200 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 2 2 1.011111 $60.5900 $59.9200
IPDEF -T1024TSTL F/U PSYCH AND DEV EVAL BY EI PROF 2 3 6.000000 $485.8800 $80.9800
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 27 27 54.000000 $4372.9200 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 2 2 4.000000 $323.9200 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 9 9 18.000000 $1457.6400 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 4 4 8.000000 $647.8400 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 13 13 26.000000 $2105.4800 $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 14 14 28.000000 $1677.7600 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 10 10 20.000000 $1198.4000 $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
NUTR -97802 NUTRITIONAL EVAL, INITIAL 13 13 36.485713 $1824.2800 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 5.142857 $257.1500 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 4 5 1.444445 $83.9400 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 5 5 4.288889 $249.2300 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.205556 $11.9500 $58.1200
OCTH -97167 OT EVAL HIGH COMPLEXITY 9 11 8.761111 $509.1100 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 3 3 1.055555 $61.3400 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 6 6 1.383333 $80.3800 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 4 5 3.238889 $188.2100 $58.1100
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 4 5 4.194444 $243.7400 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 2 2 0.466667 $27.1200 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 10 11 11.000000 $639.2100 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 0.205556 $11.9500 $58.1200
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 19 20 9.588890 $557.2200 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 8 8 42.271428 $2456.3900 $58.1100
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Subtotal (Total Children Is Unduplicated) 499 660 755.537954 $41545.1300 $54.9900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 22 24 30.303804 $151518.5000 $4999.9800
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 0.266667 $18.5000 $69.3600
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 686 801 766.416234 $38320.8500 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 161 169 161.585688 $8079.2600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 61 64 55.608154 $1390.2100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1045 1158 1937.442854 $96872.1100 $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 531 594 871.784130 $43589.2300 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 47 50 63.461116 $3173.0800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 27 48 49.638884 $1240.9600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 265 294 440.485715 $22024.2900 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 44 44 50.683336 $2534.1800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 14 22 22.333334 $558.3400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 725 747 979.667446 $48983.3100 $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 -T1027TTSC EI GROUP SESSION BY EI PROF 4 4 17.380953 $469.2800 $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 441 473 3025.657140 $163385.4900 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 22 24 149.519048 $8074.0400 $54.0000
INTR -T1013 INTERPRETER 295 420 881.285713 $44064.3000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1606 1886 11297.647590 $135571.7600 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 56 64 319.137303 $25952.2500 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 1 1 0.266667 $21.6900 $81.3300
OCCT -97530HM OT SESSION BY OT ASST 7 8 52.909524 $3445.4800 $65.1200
OCCT -97530TL OT SESSION BY LICENSED OT 7 7 24.857144 $2021.3800 $81.3200
OCCT -97530TLGO OT SESSION BY LICENSED OT 2 2 3.423810 $278.4200 $81.3200
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 0.071429 $5.8100 $81.2900
PHY -97110 PT SESSION BY LICENSED PT 46 53 280.202384 $22786.0300 $81.3200
PHY -97110GP PT SESSION BY LICENSED PT 1 1 1.000000 $81.3200 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 1 1 10.285714 $836.4300 $81.3200
PHY -97110HM PT SESSION BY PT ASST 4 4 24.714286 $1609.3900 $65.1200
PHY -97110TL PT SESSION BY LICENSED PT 6 6 14.003174 $1138.7400 $81.3200
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 1.133333 $260.2200 $229.6000
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $229.6100 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 2 0.755556 $346.9900 $459.2500
SENS -V5264 EARMOLD 5 6 3.133333 $56.8100 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 73 77 477.379364 $38820.4700 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 0.428571 $34.8500 $81.3300
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 19.000000 $1237.2800 $65.1200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 5 5 16.134920 $1312.0800 $81.3200
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 9.428571 $148.5900 $15.7600
TRAV -TRAVS Travel by mile 871 1081 6424.897596 $2859.0800 $0.4400
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Subtotal (Total Children Is Unduplicated) 3795 8498 28921.443979 $890329.8800 $30.7800
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Total 9477 32410.554162 $966667.9400 $29.8300
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Number of Children (Unduplicated) With at Least One Authorization 4218