Summary Report for FSPSAs Ending During the Report Period Center: 09
This report shows the total number of units/fees for FSPSAs ending during the report period.
(i.e., end 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 ending 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 494 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 27 27 54.474603 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 27 27 54.474603 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.466667 $12.1500 $26.0400
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.466667 $10.8000 $23.1400
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 0.466667 $36.5200 $78.2600
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 3.000000 $150.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 3 3 11.852381 $592.6200 $50.0000
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 3 3 9.714287 $564.4900 $58.1100
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Subtotal (Total Children Is Unduplicated) 8 10 25.966669 $1366.5800 $52.6300
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 94 143 221.071429 $11053.5700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 11 12 13.000000 $325.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 66 69 62.572224 $3128.6200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 26 26 24.561111 $1228.0600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 21 21 21.444444 $1072.2200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 45 46 44.394445 $2219.7300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 91 100 586.271429 $31658.6600 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 11 12 62.357142 $5070.8800 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 1 1 8.571429 $558.1700 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 10 11 51.459523 $4184.7000 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 15 16 101.999999 $8294.6300 $81.3200
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Subtotal (Total Children Is Unduplicated) 228 457 1197.703175 $68794.2300 $57.4400
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Total 494 1278.144447 $70160.8200 $54.8900
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Number of Children (Unduplicated) With at Least One Authorization 257