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
Eligibility Filter: Program Patients
With the filters selected there were 34407 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 444 450 2568.476994 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 9.333333 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 97 98 13887.803967 $634394.8800 $45.6800
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Subtotal (Total Children Is Unduplicated) 542 549 16465.614294 $634394.8800 $38.5300
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 4 4 3.522222 $411.5000 $116.8300
AACIS -92597TL AAC INTIAL EVAL BY LICENSED SLP 2 2 2.000000 $233.6600 $116.8300
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 135 145 110.985466 $5382.7900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 68 72 41.929373 $2587.4400 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 57 58 76.672224 $1164.6500 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 547 549 530.055022 $11374.9800 $21.4600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 4 4 3.216667 $83.7600 $26.0400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 522 524 519.088357 $8383.2800 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 84 84 72.085713 $1750.2400 $24.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 520 522 515.205024 $4080.4200 $7.9200
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 1.000000 $10.8800 $10.8800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 532 534 535.373581 $17030.2300 $31.8100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 4 4 2.677778 $132.7900 $49.5900
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 45 46 22.605555 $343.3800 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 562 565 561.047882 $12982.6500 $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 3 3 2.877777 $233.7800 $81.2400
AUDE -V5010 ASSESSMENT FOR HEARING AID 41 42 39.037324 $1769.1800 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 25 27 27.844445 $3224.6700 $115.8100
EXIT -EXIT COS Exit 399 410 380.443999 $19022.2000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 24 32 53.442162 $4008.1700 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 57 59 93.154718 $7543.6600 $80.9800
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 22 22 31.668341 $2564.5200 $80.9800
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 13 13 23.011111 $1863.4400 $80.9800
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 4 4 8.000000 $647.8400 $80.9800
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 10 10 16.022222 $1297.4800 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 53 54 102.222135 $6125.1400 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 27 27 40.197869 $2408.6500 $59.9200
IPDEF -T1024TSTL F/U PSYCH AND DEV EVAL BY EI PROF 31 43 78.021916 $6318.2200 $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 595 617 1190.109580 $96375.1100 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 118 123 241.500000 $19556.6700 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 215 217 432.000000 $34983.3600 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 72 72 143.000000 $11580.1400 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 206 207 409.566667 $33166.7100 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 32 33 63.500000 $5142.2300 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 620 660 1276.901491 $76511.9700 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 340 366 719.005479 $43082.8100 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 391 468 930.510958 $75352.7800 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 148 198 393.005479 $31825.5900 $80.9800
NUTR -97802 NUTRITIONAL EVAL, INITIAL 36 41 148.225393 $7411.2600 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 13 13 71.285713 $3564.2900 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 81 88 34.305326 $1993.4800 $58.1100
OCTF -97168GT OT RE-EVAL EST PLAN CARE 3 3 0.305556 $17.7600 $58.1200
OCTH -97165 OT EVAL LOW COMPLEXITY 160 167 134.680428 $7826.2600 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 10 10 7.522223 $437.1200 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 50 52 52.886736 $3073.2600 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 6 6 4.233333 $246.0000 $58.1100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 2 2 0.061112 $3.5600 $58.1900
OCTH -97167 OT EVAL HIGH COMPLEXITY 128 138 85.288884 $4956.1100 $58.1100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 4 4 3.433333 $199.5100 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 36 37 10.877777 $632.1000 $58.1100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 0.327778 $19.0500 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 55 57 35.461902 $2060.6800 $58.1100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 3 3 1.011111 $58.7600 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 99 101 79.817506 $4638.2100 $58.1100
PSTH -97161GT PT EVAL LOW COMPLEXITY 3 3 3.000000 $174.3300 $58.1100
PSTH -97161TL PT EVAL LOW COMPLEXITY 2 2 1.100000 $63.9200 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 23 23 18.219505 $1058.7400 $58.1100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 5 5 2.916666 $169.4800 $58.1100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 3 3 1.400000 $81.3500 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 72 76 40.744444 $2367.6600 $58.1100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 3 3 1.711111 $99.4300 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 43 43 12.766668 $741.8800 $58.1100
SCREEN-T1023 SCREENING 17 17 17.000000 $917.6600 $53.9800
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.411111 $6.2100 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 221 227 226.097550 $13138.5100 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 10 10 3.888889 $225.9800 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 53 56 18.155559 $1055.0400 $58.1100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 2 2 12.205556 $709.2700 $58.1100
SPCH -92522 EVAL OF SPCH SOUND PROD 10 10 5.080061 $295.2000 $58.1100
SPCH -92522GT EVAL OF SPCH SOUND PROD 3 4 3.100000 $180.1400 $58.1100
SPCH -92522TL EVAL OF SPCH SOUND PROD 2 2 0.587443 $34.1300 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 283 295 189.027432 $10984.4100 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.183333 $68.7600 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $58.1100 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 23 23 32.134648 $1867.3400 $58.1100
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.427778 $24.8600 $58.1100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 6 7 4.283333 $248.9000 $58.1100
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 2.000000 $116.2200 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 91 94 658.298407 $38253.7000 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 11 11 68.937301 $4005.9400 $58.1100
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Subtotal (Total Children Is Unduplicated) 4146 8472 11701.790396 $665740.1900 $56.8900
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 5 5 4.577778 $219.4600 $47.9400
AACFIT-92609TL AAC FITTING, ADJUST, TRAINING VISIT 1 1 0.333333 $15.9800 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 150 157 187.300218 $936501.5000 $5000.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 37 38 53.663494 $3721.5700 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 0.322222 $22.3400 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 22 22 23.188888 $5370.9900 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1223 1525 1617.431166 $80871.6000 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 260 288 273.841506 $13692.0300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 186 205 205.485269 $5137.1300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1707 1890 3090.395616 $154519.7900 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 115 132 218.527782 $10926.4100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 127 134 132.005553 $3300.1300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 882 986 1465.269844 $73263.5100 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 69 72 80.283339 $4014.2000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 39 68 59.683327 $1492.0700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 500 556 856.380571 $42819.0400 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 80 82 96.917466 $4845.9000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 22 34 38.828572 $970.7200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1180 1217 1614.178124 $80708.8500 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 105 110 112.188889 $5609.4500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 137 146 163.322223 $4083.0600 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 4 4 77.714286 $1942.8600 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 157 172 889.233327 $24009.3200 $27.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 7 8 34.499999 $1725.0100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 7519 8062 48927.698662 $2642096.2900 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 350 371 2170.722214 $117219.0200 $54.0000
INTR -T1013 INTERPRETER 343 483 1003.383332 $50169.1800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2227 2691 15846.978520 $190163.7500 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 960 1016 5200.060524 $422869.1200 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 29 29 114.878571 $9341.9200 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 6 6 22.584127 $1836.5500 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 4 4 20.428571 $1661.2500 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 118 126 714.949205 $46557.5000 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 6 6 16.390475 $1067.3500 $65.1200
OCCT -97530TL OT SESSION BY LICENSED OT 116 126 530.676982 $43154.6800 $81.3200
OCCT -97530TLGO OT SESSION BY LICENSED OT 48 48 165.278573 $13440.4600 $81.3200
OCCT -97530TLGOGT OT SESSION BY LICENSED OT 1 1 0.388889 $31.6300 $81.3200
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 2 0.165873 $13.4800 $81.2800
OCCT -97530TLHM OT SESSION BY OT ASST 13 15 42.353175 $2758.0500 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 875 919 4551.013508 $370088.5400 $81.3200
PHY -97110GP PT SESSION BY LICENSED PT 23 24 112.619049 $9158.1900 $81.3200
PHY -97110GPGT PT SESSION BY LICENSED PT 10 10 59.295239 $4821.8900 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 15 15 81.728570 $6646.1800 $81.3200
PHY -97110HM PT SESSION BY PT ASST 62 65 437.985712 $28521.6300 $65.1200
PHY -97110HMGT PT SESSION BY PT ASST 5 5 40.714286 $2651.3100 $65.1200
PHY -97110TL PT SESSION BY LICENSED PT 106 112 439.718253 $35757.8600 $81.3200
PHY -97110TLGP PT SESSION BY LICENSED PT 2 2 13.428572 $1092.0100 $81.3200
PHY -97110TLGT PT SESSION BY LICENSED PT 2 2 14.000000 $1138.4800 $81.3200
SENS -V5050 IN EAR MONAURAL HEARING AID 6 6 8.133333 $1867.4900 $229.6100
SENS -V5060 BEHIND EAR HEARING AID 17 18 19.403196 $4455.1700 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 5 6 6.755556 $3102.3100 $459.2200
SENS -V5261 BEHIND EAR DIGITAL BINAURAL HEARING 1 1 1.000000 $980.7400 $980.7400
SENS -V5264 EARMOLD 49 52 95.335270 $1728.4200 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1416 1516 7679.730238 $624515.7500 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 37 37 174.724602 $14208.6000 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 16 16 91.500000 $5958.4700 $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 166 181 729.449205 $59318.8300 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 9 10 53.690476 $4366.1100 $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 2 2 16.857142 $265.6700 $15.7600
TRAV -TRAVS Travel by mile 1197 1543 9730.161868 $4329.9200 $0.4400
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Subtotal (Total Children Is Unduplicated) 10301 25386 110450.540274 $6188490.2100 $56.0300
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Total 34407 138617.944964 $7488625.2700 $54.0200
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Number of Children (Unduplicated) With at Least One Authorization 12237