Summary Report for FSPSAs Initiated During the Report Period Statewide
This report shows the total number of units/fees for FSPSAs initiated during the report period.
(i.e., start 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 starting 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 18953 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 294 295 866.999209 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 51 51 8743.652381 $399410.0400 $45.6800
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 345 346 9610.651590 $399410.0400 $41.5600
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 2 2 2.000000 $233.6600 $116.8300
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 48 51 38.210656 $1853.2200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 43 44 36.273810 $2238.4600 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 26 26 41.426190 $629.2600 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 211 213 210.416667 $4515.5400 $21.4600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 2 2.000000 $52.0800 $26.0400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 203 205 204.127778 $3296.6600 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 39 40 32.055555 $778.3100 $24.2800
AUDE -92558 OTOACOUSTIC EMISSIONS (SCREENING) 22 22 22.000000 $151.1400 $6.8700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 183 185 184.244445 $1459.2200 $7.9200
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 22 22 22.000000 $239.3600 $10.8800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 184 186 184.288889 $5862.2300 $31.8100
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 39 40 32.794444 $498.1500 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 200 202 203.488096 $4708.7100 $23.1400
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 1.000000 $78.2500 $78.2500
AUDE -V5010 ASSESSMENT FOR HEARING AID 11 12 13.636508 $618.0100 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 5 4.677778 $541.7400 $115.8100
EXIT -EXIT COS Exit 277 282 257.166221 $12858.3100 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 17 25 45.825495 $3436.9100 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 35 35 55.625114 $4504.5100 $80.9800
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 14 14 22.350837 $1809.9800 $80.9800
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 8 8 14.011111 $1134.6200 $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 6 6 8.022222 $649.6400 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 37 37 67.150000 $4023.6300 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 20 20 26.164992 $1567.8000 $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 61 64 124.000000 $10041.5200 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 128 129 256.000000 $20730.8800 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 57 57 113.000000 $9150.7400 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 128 129 257.500000 $20852.3500 $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 433 455 872.812907 $52298.9700 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 251 274 535.505479 $32087.4900 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 269 323 644.000000 $52151.1200 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 116 156 318.362622 $25781.0000 $80.9800
NUTR -97802 NUTRITIONAL EVAL, INITIAL 15 16 45.612699 $2280.6400 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 3 3 23.285714 $1164.2900 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 47 53 22.427093 $1303.2400 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 67 68 59.283333 $3444.9500 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 0.127778 $7.4300 $58.1200
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 1 0.266667 $15.5000 $58.1200
OCTH -97166 OT EVAL MODERATE COMPLEXITY 28 28 26.748859 $1554.3800 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 3 3 1.611111 $93.6200 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 58 65 45.716668 $2656.6000 $58.1100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 5 5 2.350000 $136.5600 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 29 30 10.616663 $616.9100 $58.1100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 17 17 8.488205 $493.2600 $58.1100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 1 1 0.316667 $18.4000 $58.1200
PSTH -97161 PT EVAL LOW COMPLEXITY 35 35 21.644443 $1257.7500 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 9 9 7.174962 $416.9300 $58.1100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 0.427778 $24.8600 $58.1100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 0.250000 $14.5300 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 33 33 18.649999 $1083.7500 $58.1100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 4 4 2.066666 $120.0900 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 14 15 4.644442 $269.8700 $58.1100
SCREEN-T1023 SCREENING 15 15 15.000000 $809.7000 $53.9800
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.377778 $5.7100 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 81 83 65.914645 $3830.3000 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 4 4 0.883334 $51.3300 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 21 22 10.811110 $628.2300 $58.1100
SPCH -92522 EVAL OF SPCH SOUND PROD 5 5 4.489498 $260.8900 $58.1100
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 0.422222 $24.5300 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 116 121 85.071907 $4943.5300 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 6 6 2.661111 $154.6400 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 3.944444 $229.2100 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 9 9 6.583485 $382.5600 $58.1100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 0.577778 $33.5800 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 45 46 312.904759 $18182.9100 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 6 6 30.578571 $1776.9200 $58.1100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 2261 4453 6578.688743 $400734.8000 $60.9100
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 2 2 2.000000 $95.8800 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 54 58 60.025420 $300127.5000 $5000.0100
AUD -92630 AUD REHAB PRELING HEARING LOSS 17 17 17.362700 $1204.1200 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.133333 $9.2400 $69.3300
AUDE -V5160 DISPENSING FEE BINAURAL 5 5 6.000000 $1389.7200 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 777 942 952.111122 $47605.5800 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 161 171 159.242556 $7962.1100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 130 140 130.371995 $3259.3000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 947 1025 1673.374691 $83668.7700 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 64 67 92.594443 $4629.7200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 84 88 110.452383 $2761.3200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 431 489 806.489681 $40324.4900 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 52 54 80.496028 $4024.7900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 34 58 80.883333 $2022.0800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 269 292 477.402848 $23870.1500 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 36 36 50.327778 $2516.3900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 19 28 28.800002 $720.0100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 605 617 818.403160 $40920.0900 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 50 50 66.749205 $3337.4600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 85 89 133.262700 $3331.5800 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 90 97 767.192053 $20714.2000 $27.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 2 2 10.642857 $532.1500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 4293 4616 31461.778176 $1698936.8800 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 258 276 1817.475374 $98143.7500 $54.0000
INTR -T1013 INTERPRETER 302 437 840.338094 $42016.9200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1372 1620 10559.494581 $126713.9900 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 374 399 2400.211098 $195185.2500 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 9 9 0.847620 $68.9300 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 6 6 7.534921 $612.7400 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 3 3 28.714285 $2335.0500 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 69 72 600.161900 $39082.5400 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 3 3 30.857143 $2009.4100 $65.1200
OCCT -97530TL OT SESSION BY LICENSED OT 95 99 601.120629 $48883.2200 $81.3200
OCCT -97530TLGO OT SESSION BY LICENSED OT 37 39 131.589681 $10700.8900 $81.3200
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 0.071429 $5.8100 $81.2900
OCCT -97530TLGTHM OT SESSION BY OT ASST 2 2 11.142857 $725.6300 $65.1200
OCCT -97530TLHM OT SESSION BY OT ASST 9 11 15.928570 $1037.2800 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 359 371 2054.735701 $167091.1300 $81.3200
PHY -97110GP PT SESSION BY LICENSED PT 10 11 75.714285 $6157.0800 $81.3200
PHY -97110GPGT PT SESSION BY LICENSED PT 1 1 0.466667 $37.9500 $81.3300
PHY -97110GT PT SESSION BY LICENSED PT 3 3 28.571429 $2323.4300 $81.3200
PHY -97110HM PT SESSION BY PT ASST 30 31 195.654760 $12741.0300 $65.1200
PHY -97110HMGT PT SESSION BY PT ASST 2 2 6.000000 $390.7200 $65.1200
PHY -97110TL PT SESSION BY LICENSED PT 95 98 548.372218 $44593.6600 $81.3200
PHY -97110TLGP PT SESSION BY LICENSED PT 1 2 6.857143 $557.6200 $81.3200
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 6.428571 $522.7700 $81.3200
SENS -V5060 BEHIND EAR HEARING AID 4 5 5.000000 $1148.0500 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 2 1.677778 $770.4800 $459.2300
SENS -V5264 EARMOLD 15 16 27.046034 $490.3500 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 542 570 3310.718309 $269227.6900 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 20 21 101.616666 $8263.4700 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 5 5 55.571428 $3618.8100 $65.1200
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 7.285714 $474.4400 $65.1200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 121 123 536.676975 $43642.6500 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 2 3 5.465079 $444.4200 $81.3200
TRAV -TRAVS Travel by mile 769 967 6244.385125 $2778.7500 $0.4400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 5783 14154 68249.828528 $3426759.3900 $50.2100
-------------------------------------------------------------------------------------------------------------------------------------
Total 18953 84439.168861 $4226904.2200 $50.0600
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 6765