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 16389 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 399 404 2511.659532 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 9.333333 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 25 25 3012.676191 $137619.0500 $45.6800
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Subtotal (Total Children Is Unduplicated) 425 430 5533.669056 $137619.0500 $24.8700
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 3 3 2.522222 $294.6700 $116.8300
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 100 108 83.717049 $4060.2700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 11 12 7.784932 $480.4100 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 2 2 2.800000 $42.5300 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 40 40 33.833331 $726.0600 $21.4600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.450000 $11.7200 $26.0400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 30 30 30.000000 $484.5000 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 13 13 10.183333 $247.2500 $24.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 29 29 29.000000 $229.6800 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 33 33 32.779669 $1042.7200 $31.8100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 3 1.911111 $94.7700 $49.5900
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 15 15 7.127778 $108.2700 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 32 32 35.832540 $829.1600 $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 2 2 1.877777 $152.5400 $81.2400
AUDE -V5010 ASSESSMENT FOR HEARING AID 9 9 6.742086 $305.5600 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 9 10 8.122222 $940.6300 $115.8100
EXIT -EXIT COS Exit 378 389 363.910666 $18195.5300 $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 11 12 22.011111 $1782.4600 $80.9800
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 4 4 4.180974 $338.5800 $80.9800
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 3 3 6.000000 $485.8800 $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 12 12 27.857143 $1669.2000 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 6 6 9.011111 $539.9500 $59.9200
IPDEF -T1024TSTL F/U PSYCH AND DEV EVAL BY EI PROF 4 6 12.000000 $971.7600 $80.9800
IPDEF -T1024TSTLGT F/U PHYC AND DEV EVAL BY EI PROF 1 2 4.000000 $323.9200 $80.9800
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 106 109 212.510958 $17209.1400 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 21 22 43.500000 $3522.6300 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 32 33 66.000000 $5344.6800 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 13 13 26.000000 $2105.4800 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 44 44 86.000000 $6964.2800 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 7 8 15.500000 $1255.1900 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 90 93 181.510958 $10876.1400 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 68 69 137.500000 $8239.0000 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 39 47 95.000000 $7693.1000 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 22 32 63.500000 $5142.2300 $80.9800
NUTR -97802 NUTRITIONAL EVAL, INITIAL 18 18 45.101586 $2255.0700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 5.142857 $257.1500 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 22 23 10.588889 $615.3200 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 19 19 16.777778 $974.9600 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 4 4 3.350000 $194.6700 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 7 7 6.696826 $389.1600 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 0.005556 $0.3300 $58.5700
OCTH -97167 OT EVAL HIGH COMPLEXITY 24 27 19.572223 $1137.3500 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 6 6 2.733333 $158.8300 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 16 16 6.433332 $373.8300 $58.1100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 2 2 1.177778 $68.4400 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 19 20 15.722223 $913.6200 $58.1100
PSTH -97161GT PT EVAL LOW COMPLEXITY 2 2 2.000000 $116.2200 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 1.011111 $58.7600 $58.1100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 0.388889 $22.6000 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 19 21 11.727778 $681.5000 $58.1100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.372222 $21.6300 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 9 9 2.411111 $140.1100 $58.1100
SCREEN-T1023 SCREENING 3 3 3.000000 $161.9400 $53.9800
SPCH -92521 EVAL OF SPEECH FLUENCY 39 40 50.172221 $2915.5000 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 4 4 1.722223 $100.0800 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 2 2 0.750000 $43.5800 $58.1100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 12.000000 $697.3200 $58.1100
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 2 2.000000 $116.2200 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 73 76 47.065874 $2735.0100 $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 5 5 3.816667 $221.7900 $58.1100
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.427778 $24.8600 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 14 14 87.700000 $5096.2400 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 2 2 14.428571 $838.4500 $58.1100
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Subtotal (Total Children Is Unduplicated) 1107 1582 2053.140464 $124639.7000 $60.7100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 58 60 68.781538 $343907.5000 $5000.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 4 4 3.722223 $258.1400 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 2.411111 $558.4600 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1055 1253 1254.848845 $62742.4900 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 258 286 273.336027 $13666.7600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 83 88 80.933116 $2023.3300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1580 1756 2958.231747 $147911.5800 $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 819 922 1392.267463 $69613.3900 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 69 72 80.283339 $4014.2000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 37 66 58.238883 $1455.9600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 454 507 809.708729 $40485.4400 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 80 82 96.917466 $4845.9000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 20 32 36.828572 $920.7200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1109 1146 1545.253161 $77262.5900 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 105 110 112.188889 $5609.4500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 136 145 162.322223 $4058.0600 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 9 9 28.390477 $766.5400 $27.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 5 6 21.928571 $1096.4400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1928 2056 12708.109494 $686238.0100 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 73 76 462.952383 $24999.4400 $54.0000
INTR -T1013 INTERPRETER 325 458 968.633332 $48431.6800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2227 2691 15846.978520 $190163.7500 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 177 190 897.120637 $72953.9200 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 3 3 4.628571 $376.4000 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 2 2 10.142857 $824.8200 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 2.142857 $174.2600 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 27 28 191.623810 $12478.5500 $65.1200
OCCT -97530TL OT SESSION BY LICENSED OT 11 11 45.857144 $3729.1000 $81.3200
OCCT -97530TLGO OT SESSION BY LICENSED OT 3 3 15.709524 $1277.5000 $81.3200
OCCT -97530TLGOGT OT SESSION BY LICENSED OT 1 1 0.388889 $31.6300 $81.3200
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 0.071429 $5.8100 $81.2900
PHY -97110 PT SESSION BY LICENSED PT 137 146 720.380959 $58581.3700 $81.3200
PHY -97110GP PT SESSION BY LICENSED PT 3 3 11.214286 $911.9500 $81.3200
PHY -97110GPGT PT SESSION BY LICENSED PT 5 5 36.176190 $2941.8400 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 3 3 18.519047 $1505.9700 $81.3200
PHY -97110HM PT SESSION BY PT ASST 10 10 74.714286 $4865.3900 $65.1200
PHY -97110HMGT PT SESSION BY PT ASST 1 1 10.285714 $669.8000 $65.1200
PHY -97110TL PT SESSION BY LICENSED PT 11 11 49.860317 $4054.6400 $81.3200
PHY -97110TLGP PT SESSION BY LICENSED PT 1 1 7.571429 $615.7100 $81.3200
SENS -V5050 IN EAR MONAURAL HEARING AID 3 3 3.133333 $719.4400 $229.6100
SENS -V5060 BEHIND EAR HEARING AID 5 5 3.403196 $781.4100 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 2 0.755556 $346.9900 $459.2500
SENS -V5264 EARMOLD 13 14 27.796065 $503.9400 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 255 270 1415.919045 $115142.5300 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 10 10 48.733333 $3962.9900 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 5 5 30.571428 $1990.8100 $65.1200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 10 10 48.063491 $3908.5100 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 3 3 21.285714 $1730.9500 $81.3200
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 9.428571 $148.5900 $15.7600
TRAV -TRAVS Travel by mile 1195 1541 9725.733297 $4327.9500 $0.4400
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Subtotal (Total Children Is Unduplicated) 6226 14377 52755.030419 $2044819.0700 $38.7600
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Total 16389 60341.839939 $2307077.8300 $38.2300
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Number of Children (Unduplicated) With at Least One Authorization 6998