Summary Report for FSPSAs Initiated During the Report Period Center: 09
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 2559 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 28 45.625397 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 27 28 45.625397 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 3 3 1.577777 $33.8600 $21.4600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 3 3 1.577777 $41.0800 $26.0400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 3 1.577777 $25.4800 $16.1500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 3 3 1.577777 $12.5000 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 3 1.577777 $50.1900 $31.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 3 3 1.577777 $36.5100 $23.1400
AUDE -92651 AEP HEARING STATUS DETER I&R 3 3 1.577777 $123.4600 $78.2500
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 1.544444 $69.9900 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 1.544444 $178.8600 $115.8100
NUTR -97802 NUTRITIONAL EVAL, INITIAL 6 6 15.457144 $772.8500 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 16 16 112.523809 $5626.2000 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 2.142857 $124.5200 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 25 28 201.571429 $11713.3100 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 3.000000 $174.3300 $58.1100
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Subtotal (Total Children Is Unduplicated) 49 77 348.828566 $18983.1300 $54.4200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 244 364 480.166821 $24008.3700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 120 161 160.139961 $4003.5100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 138 149 119.613494 $5980.6900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.172222 $4.3100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 78 80 73.641269 $3682.0600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 47 47 35.822222 $1791.1100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.172222 $4.3100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 95 97 86.911112 $4345.5600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.311111 $32.7800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 880 985 6229.742929 $336405.8400 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 126 147 783.630963 $63724.7800 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 17 19 104.285715 $6791.0800 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 127 148 951.257145 $77356.2400 $81.3200
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.033333 $3.8200 $114.7000
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 1.544444 $354.6100 $229.6000
SENS -V5264 EARMOLD 3 3 1.577777 $28.6000 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 216 246 1517.728587 $123421.5600 $81.3200
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Subtotal (Total Children Is Unduplicated) 1093 2454 10548.751327 $656939.2000 $62.2800
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Total 2559 10943.205290 $675922.3300 $61.7700
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Number of Children (Unduplicated) With at Least One Authorization 1122