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 14553 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 364 366 2460.573810 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 20 20 2677.333333 $122300.5900 $45.6800
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Subtotal (Total Children Is Unduplicated) 384 386 5137.907143 $122300.5900 $23.8000
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 67 71 50.255100 $2437.3800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 17 17 13.977777 $862.5600 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 6 6 6.361111 $96.6300 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 31 31 21.211112 $455.1900 $21.4600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.050000 $1.3000 $26.0400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 20 20 19.041096 $307.5100 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 8 8 5.766666 $140.0100 $24.2800
AUDE -92558 OTOACOUSTIC EMISSIONS (SCREENING) 1 1 1.000000 $6.8700 $6.8700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 18 18 18.000000 $142.5600 $7.9200
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 1.000000 $10.8800 $10.8800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 18 18 18.000000 $572.5800 $31.8100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 0.622222 $30.8500 $49.5900
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 11 11 5.194444 $78.9000 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 23 23 26.915874 $622.8300 $23.1400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 -1.011111 $-55.5100 $54.9000
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 0.488889 $38.2600 $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 8 8 14.496031 $656.9600 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 1.955556 $226.4800 $115.8100
EXIT -EXIT COS Exit 378 387 360.882888 $18044.1400 $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 2 2 3.000000 $242.9400 $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 16 16 32.862699 $1969.1300 $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 91 94 185.796672 $11132.9400 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 67 68 135.500000 $8119.1600 $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 10 10 19.123810 $956.1900 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 16 17 6.977093 $405.4400 $58.1100
OCTF -97168GT OT RE-EVAL EST PLAN CARE 1 1 10.428571 $606.0100 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 19 20 14.772223 $858.4200 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 7 7 7.027778 $408.3900 $58.1100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 0.005556 $0.3300 $58.5700
OCTH -97167 OT EVAL HIGH COMPLEXITY 24 27 20.222223 $1175.1200 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 5 5 3.016666 $175.2900 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 11 12 4.242847 $246.5600 $58.1100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 2 2 1.177778 $68.4400 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 21 21 16.888889 $981.4100 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 4 4 2.705403 $157.2100 $58.1100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 0.122222 $7.1000 $58.1000
PSTH -97163 PT EVAL HIGH COMPLEXITY 16 18 11.805556 $686.0200 $58.1100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.172222 $10.0100 $58.1000
PSTH -97163TL PT EVAL HIGH COMPLEXITY 2 2 0.661111 $38.4200 $58.1100
SCREEN-T1023 SCREENING 3 3 3.000000 $161.9400 $53.9800
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 2 0.611111 $9.2300 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 41 42 44.866960 $2607.2200 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 3 3 2.011111 $116.8700 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 2 2 0.588889 $34.2200 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 67 71 38.222329 $2221.0900 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $58.1100 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.422222 $24.5300 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 8 8 5.166667 $300.2400 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 13 14 120.666666 $7011.9400 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 2 2 9.571429 $556.1900 $58.1100
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Subtotal (Total Children Is Unduplicated) 1021 1454 1940.336290 $120350.3400 $62.0300
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 2 2 2.000000 $95.8800 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 44 48 62.377626 $311888.5000 $5000.0100
AUD -92630 AUD REHAB PRELING HEARING LOSS 3 3 5.366667 $372.1800 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.350000 $24.2700 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 4 4 5.000000 $1158.1000 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1064 1254 1199.878891 $59993.9900 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 250 278 254.642179 $12732.0700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 90 94 107.443576 $2686.0900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1367 1496 2511.056628 $125552.8900 $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 647 730 1294.372222 $64718.6300 $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 409 452 787.211385 $39360.5800 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 68 69 96.422224 $4821.1200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 28 41 34.200003 $855.0100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 916 944 1364.342052 $68217.0600 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 93 96 124.673017 $6233.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 124 130 178.257143 $4456.4300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 10 10 49.919046 $1347.8200 $27.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 5 5 22.576190 $1128.8100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1574 1723 11341.450660 $612438.6200 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 87 92 509.666661 $27522.0300 $54.0000
INTR -T1013 INTERPRETER 315 451 868.802380 $43440.1300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1927 2347 15157.780231 $181893.4400 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 138 144 662.806350 $53899.4700 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 5 5 4.683333 $380.8500 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 1 1 3.071429 $249.7700 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 3.714286 $302.0500 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 19 21 136.999999 $8921.4300 $65.1200
OCCT -97530TL OT SESSION BY LICENSED OT 11 12 23.269840 $1892.2900 $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
OCCT -97530TLGTHM OT SESSION BY OT ASST 1 1 12.142857 $790.7500 $65.1200
OCCT -97530TLHM OT SESSION BY OT ASST 1 1 1.000000 $65.1200 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 135 140 930.635710 $75679.3300 $81.3200
PHY -97110GP PT SESSION BY LICENSED PT 2 2 10.000000 $813.2000 $81.3200
PHY -97110GPGT PT SESSION BY LICENSED PT 2 2 10.428571 $848.0500 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 1 1 -26.000000 $-2114.3200 $81.3200
PHY -97110HM PT SESSION BY PT ASST 9 9 71.571429 $4660.7200 $65.1200
PHY -97110HMGT PT SESSION BY PT ASST 1 1 9.285714 $604.6800 $65.1200
PHY -97110TL PT SESSION BY LICENSED PT 5 6 44.288889 $3601.5800 $81.3200
SENS -V5060 BEHIND EAR HEARING AID 4 4 4.277778 $982.2300 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 2 1.677778 $770.4800 $459.2300
SENS -V5264 EARMOLD 10 10 19.885715 $360.5300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 251 260 1545.040460 $125642.7600 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 10 10 53.909523 $4383.9300 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 3 16.000000 $1041.9100 $65.1200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 9 9 25.380952 $2063.9700 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 3 3 -16.142857 $-1312.7300 $81.3200
TRAV -TRAVS Travel by mile 1059 1392 8849.470812 $3938.0100 $0.4400
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Subtotal (Total Children Is Unduplicated) 5362 12713 48895.511157 $1879080.4400 $38.4300
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Total 14553 55973.754590 $2121731.3700 $37.9100
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Number of Children (Unduplicated) With at Least One Authorization 6169