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
Eligibility Filter: Program Patients
With the filters selected there were 29305 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 398 400 2506.173809 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 69 69 10858.574603 $496019.6800 $45.6800
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Subtotal (Total Children Is Unduplicated) 467 469 13364.748412 $496019.6800 $37.1100
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 92 97 78.625192 $3813.3300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 70 71 53.801589 $3320.1000 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 45 45 62.592856 $950.7800 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 318 322 309.627779 $6644.6100 $21.4600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 4 4 3.050000 $79.4200 $26.0400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 301 305 302.724430 $4889.0000 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 61 62 47.388888 $1150.6000 $24.2800
AUDE -92558 OTOACOUSTIC EMISSIONS (SCREENING) 33 33 33.000000 $226.7100 $6.8700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 268 272 270.788889 $2144.6500 $7.9200
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 34 34 33.094444 $360.0700 $10.8800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 268 272 270.288889 $8597.8900 $31.8100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 0.622222 $30.8500 $49.5900
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 67 68 52.355556 $795.2800 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 300 304 300.773016 $6959.8900 $23.1400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 -1.011111 $-55.5100 $54.9000
AUDE -92651 AEP HEARING STATUS DETER I&R 2 2 1.488889 $116.5100 $78.2500
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 1 1 0.277778 $22.5700 $81.2500
AUDE -V5010 ASSESSMENT FOR HEARING AID 22 23 25.125397 $1138.6900 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 12 13 10.524963 $1218.9000 $115.8100
EXIT -EXIT COS Exit 400 409 378.416221 $18920.8100 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 22 30 49.847717 $3738.5800 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 52 53 87.980669 $7124.6600 $80.9800
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 21 21 33.098478 $2680.3200 $80.9800
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 12 12 22.011111 $1782.4600 $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 15.022222 $1216.5000 $80.9800
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 1 1 1.000000 $80.9800 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 51 52 100.012699 $5992.7600 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 28 28 40.164992 $2406.6800 $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 117 122 239.500000 $19394.7100 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 214 216 430.000000 $34821.4000 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 73 73 145.000000 $11742.1000 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 204 205 405.566667 $32842.7900 $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 623 663 1275.901490 $76452.0500 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 335 361 709.005479 $42483.6100 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 389 465 924.510958 $74866.9000 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 145 196 397.862622 $32218.9100 $80.9800
NUTR -97802 NUTRITIONAL EVAL, INITIAL 25 26 72.840726 $3642.0400 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 4 4 25.219047 $1260.9500 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 72 79 37.182650 $2160.6900 $58.1100
OCTF -97168GT OT RE-EVAL EST PLAN CARE 2 2 10.678571 $620.5300 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 131 134 158.164287 $9190.9300 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 2 2 1.127778 $65.5400 $58.1100
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 1 0.266667 $15.5000 $58.1200
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 54 54 49.636150 $2884.3500 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 4 4 2.611111 $151.7300 $58.1100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 0.005556 $0.3300 $58.5700
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 0.461111 $26.7900 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 93 104 72.510883 $4213.6100 $58.1100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 5 5 2.350000 $136.5600 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 41 42 15.916662 $924.8900 $58.1100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 38 39 19.276181 $1120.1500 $58.1100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 5 5 1.838889 $106.8600 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 79 80 60.005554 $3486.9100 $58.1100
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 21 21 15.213698 $884.0600 $58.1100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 2 2 0.550000 $31.9600 $58.1100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 0.250000 $14.5300 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 61 65 36.877777 $2142.9600 $58.1100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 4 4 2.066666 $120.0900 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 26 27 9.033332 $524.9200 $58.1100
SCREEN-T1023 SCREENING 23 23 23.000000 $1241.5400 $53.9800
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 3 1.222222 $18.4700 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 180 184 207.173918 $12038.8700 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 9 9 4.172223 $242.4500 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 37 38 16.005556 $930.0900 $58.1100
SPCH -92522 EVAL OF SPCH SOUND PROD 9 9 7.571690 $440.0000 $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 223 233 151.503672 $8803.8700 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 7 7 3.661111 $212.7500 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 5 5 4.366666 $253.7400 $58.1100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.483333 $28.0800 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 22 22 16.194596 $941.0600 $58.1100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 7 7 4.166667 $242.1300 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 82 88 609.714281 $35430.5000 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 13 13 74.483334 $4328.2300 $58.1100
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Subtotal (Total Children Is Unduplicated) 3545 6899 10178.897274 $619451.0300 $60.8600
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 3 3 3.000000 $143.8200 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 118 129 138.805633 $694030.0000 $5000.0100
AUD -92630 AUD REHAB PRELING HEARING LOSS 33 33 47.946827 $3325.1300 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 3 0.872222 $60.4900 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 20 20 22.611111 $5237.1800 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1220 1502 1516.292002 $75814.6400 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 252 280 255.147658 $12757.3400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 198 219 229.121126 $5728.0300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1507 1642 2669.100767 $133455.1000 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 107 115 155.033334 $7751.6700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 123 129 149.152381 $3728.8100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 701 786 1369.664284 $68483.2300 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 77 80 122.840473 $6142.0200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 46 75 98.230953 $2455.7800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 475 522 865.971899 $43298.6100 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 68 69 96.422224 $4821.1200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 29 42 35.200003 $880.0100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 994 1024 1443.342724 $72167.0800 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 93 96 124.673017 $6233.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 125 131 179.268254 $4481.7100 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 31.428571 $785.7200 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 114 121 924.925382 $24973.0100 $27.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 7 7 34.500000 $1725.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6265 6771 45157.624695 $2438512.9500 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 367 389 2431.724571 $131313.2400 $54.0000
INTR -T1013 INTERPRETER 334 478 917.123808 $45856.2000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1927 2347 15157.780231 $181893.4400 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 702 744 4284.481719 $348414.1600 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 20 20 30.845238 $2508.3200 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 7 7 10.606350 $862.5000 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 5 5 32.714285 $2660.3300 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 115 122 930.113485 $60569.0000 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 5 5 50.000000 $3256.0000 $65.1200
OCCT -97530TL OT SESSION BY LICENSED OT 118 122 711.109516 $57827.5100 $81.3200
OCCT -97530TLGO OT SESSION BY LICENSED OT 38 40 135.989681 $11058.7000 $81.3200
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 0.071429 $5.8100 $81.2900
OCCT -97530TLGTHM OT SESSION BY OT ASST 3 3 23.285714 $1516.3700 $65.1200
OCCT -97530TLHM OT SESSION BY OT ASST 11 13 19.328570 $1258.6800 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 715 748 4272.691239 $347455.3600 $81.3200
PHY -97110GP PT SESSION BY LICENSED PT 15 16 98.999999 $8050.6800 $81.3200
PHY -97110GPGT PT SESSION BY LICENSED PT 6 6 35.752380 $2907.3900 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 5 5 7.000000 $569.2400 $81.3200
PHY -97110HM PT SESSION BY PT ASST 56 57 379.383330 $24705.4300 $65.1200
PHY -97110HMGT PT SESSION BY PT ASST 3 3 15.285714 $995.4000 $65.1200
PHY -97110TL PT SESSION BY LICENSED PT 113 116 674.310314 $54834.9500 $81.3200
PHY -97110TLGP PT SESSION BY LICENSED PT 1 2 6.857143 $557.6200 $81.3200
PHY -97110TLGT PT SESSION BY LICENSED PT 3 3 15.969841 $1298.6700 $81.3200
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 2.000000 $229.6200 $114.8100
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 1.000000 $229.6100 $229.6100
SENS -V5060 BEHIND EAR HEARING AID 11 12 14.277778 $3278.3300 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 3 3 2.677778 $1229.7000 $459.2200
SENS -V5261 BEHIND EAR DIGITAL BINAURAL HEARING 3 3 5.000000 $4903.7000 $980.7400
SENS -V5264 EARMOLD 43 44 96.286324 $1745.6700 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1141 1210 7147.172238 $581208.2400 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 36 39 181.407141 $14752.0400 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 12 13 107.785713 $7019.0000 $65.1200
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 2 2 26.142857 $1702.4200 $65.1200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 150 154 685.918245 $55778.9300 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 7 8 -7.236508 $-588.4600 $81.3200
SPL -92508HA GROUP SPL SESSION PER CHILD 2 2 8.428571 $132.8300 $15.7600
TRAV -TRAVS Travel by mile 1060 1393 8851.470812 $3938.9000 $0.4400
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Subtotal (Total Children Is Unduplicated) 8778 21937 103034.931046 $5582927.6100 $54.1800
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Total 29305 126578.576732 $6698398.3300 $52.9200
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Number of Children (Unduplicated) With at Least One Authorization 10226