Summary Report for FSPSAs Initiated During the Report Period Center: 04
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: 01-01-24 and 03-31-24 Date of Report: 04-04-25 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2469 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 82 87 47.703171 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 82 87 47.703171 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 7 7 7.000000 $431.9700 $61.7100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 74 78 22.676991 $1317.7900 $58.1100
PSTH -97161TL PT EVAL LOW COMPLEXITY 2 2 0.727778 $42.2900 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 59 61 13.922221 $809.0100 $58.1100
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 1.000000 $15.1100 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.455556 $26.4700 $58.1200
SPCH -92521TL EVAL OF SPEECH FLUENCY 62 65 15.061114 $875.2200 $58.1100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 4 0.927778 $53.9100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 2 2 32.571429 $1892.7200 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 2 2 12.142857 $705.6200 $58.1100
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Subtotal (Total Children Is Unduplicated) 142 223 106.485724 $6170.1300 $57.9400
EI Services, Class # 03
AUDE -V5160 DISPENSING FEE BINAURAL 5 5 5.000000 $1158.1000 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 29 59 10.050001 $502.5100 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 6 6 7.701587 $385.0800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 7 7 5.036507 $251.8200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 4 5 2.311111 $115.5600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 5 5 4.350794 $217.5400 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 102 121 629.857152 $17006.1400 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 738 815 5159.244463 $278599.2000 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 5 5 39.428572 $2129.1400 $54.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 737 811 5208.176208 $62498.1100 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 14.428572 $1173.3300 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 112 121 571.428581 $46468.5300 $81.3200
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 12.428571 $1010.6900 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 82 88 393.357147 $31987.7600 $81.3200
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.000000 $459.2200 $459.2200
SENS -V5264 EARMOLD 2 2 2.000000 $36.2600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 5.428571 $441.4500 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 98 104 479.247622 $38972.3800 $81.3200
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Subtotal (Total Children Is Unduplicated) 890 2159 12550.475459 $483412.8100 $38.5200
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Total 2469 12704.664354 $489582.9500 $38.5400
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Number of Children (Unduplicated) With at Least One Authorization 948