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 8209 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 273 274 843.219844 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 6 6 563.755556 $25752.3600 $45.6800
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Subtotal (Total Children Is Unduplicated) 279 280 1406.975400 $25752.3600 $18.3000
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 1 1 1.000000 $116.8300 $116.8300
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 41 44 30.593989 $1483.8100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 4 4 8.211111 $506.7100 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 1.000000 $15.1900 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 11 11 11.000000 $236.0600 $21.4600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 10 10 10.000000 $161.5000 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 2.488889 $60.4300 $24.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 10 10 10.000000 $79.2000 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 10 10 10.000000 $318.1000 $31.8100
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 0.955555 $14.5100 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 13 13 18.038096 $417.4000 $23.1400
AUDE -V5010 ASSESSMENT FOR HEARING AID 5 5 10.496031 $475.6800 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.677778 $78.5000 $115.8100
EXIT -EXIT COS Exit 271 276 253.132888 $12656.6400 $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 6 6 10.000000 $599.2000 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 1 0.011111 $0.6700 $59.8600
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 15 15 32.285714 $1934.5600 $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 9 9 18.290477 $914.5300 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 4 5 1.365982 $79.3800 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.277778 $16.1400 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 10 12 8.494445 $493.6200 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 2 2 0.772222 $44.8700 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.049315 $2.8600 $58.0900
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.166667 $9.6900 $58.1200
PSTH -97163 PT EVAL HIGH COMPLEXITY 5 5 4.472222 $259.8800 $58.1100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.172222 $10.0100 $58.1000
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 0.344444 $20.0100 $58.1000
SCREEN-T1023 SCREENING 1 1 1.000000 $53.9800 $53.9800
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.377778 $5.7100 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 8 8 7.466667 $433.8900 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 0.350000 $20.3400 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 19 20 8.854869 $514.5500 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 9 9 91.095238 $5293.5500 $58.1100
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Subtotal (Total Children Is Unduplicated) 459 582 734.452599 $41542.2000 $56.5600
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 1 1 1.000000 $47.9400 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 16 18 23.150685 $115753.5000 $5000.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 2.800000 $194.1800 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $231.6200 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 686 799 770.600446 $38530.0500 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 159 169 158.737077 $7936.8300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 64 65 59.090042 $1477.2500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 871 944 1593.055036 $79652.7900 $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 410 466 783.811904 $39190.6100 $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 223 243 418.086779 $20904.3400 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 36 36 50.327778 $2516.3900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 18 27 27.800002 $695.0100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 563 574 771.112686 $38555.5800 $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 2 2 5.400000 $145.8000 $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 346 372 2485.336475 $134208.2600 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 22 24 111.855555 $6040.2100 $54.0000
INTR -T1013 INTERPRETER 285 412 795.016666 $39750.8400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1372 1620 10559.494581 $126713.9900 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 49 54 336.723811 $27382.4200 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 1 1 0.266667 $21.6900 $81.3300
OCCT -97530HM OT SESSION BY OT ASST 5 5 35.285714 $2297.8000 $65.1200
OCCT -97530TL OT SESSION BY LICENSED OT 5 6 35.500000 $2886.8600 $81.3200
OCCT -97530TLGO OT SESSION BY LICENSED OT 3 3 -5.004762 $-406.9800 $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 47 370.643650 $30140.7500 $81.3200
PHY -97110GP PT SESSION BY LICENSED PT 1 1 3.857143 $313.6600 $81.3200
PHY -97110HM PT SESSION BY PT ASST 1 1 10.857143 $707.0100 $65.1200
PHY -97110TL PT SESSION BY LICENSED PT 4 5 36.146032 $2939.4000 $81.3200
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $229.6100 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 2 1.677778 $770.4800 $459.2300
SENS -V5264 EARMOLD 3 3 7.912699 $143.4600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 64 64 410.338093 $33368.7300 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 9.285714 $755.1100 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 3 3 19.776190 $1608.2000 $81.3200
TRAV -TRAVS Travel by mile 769 967 6244.385125 $2778.7500 $0.4400
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Subtotal (Total Children Is Unduplicated) 3200 7347 26711.479087 $779127.0100 $29.1700
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Total 8209 28852.907086 $846421.5600 $29.3400
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Number of Children (Unduplicated) With at Least One Authorization 3701