Summary Report for FSPSAs Ending During the Report Period Center: 53
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 666 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 13 15 16.116666 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 13 15 16.116666 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 8 9 8.161111 $395.8100 $48.5000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 2 2 1.172222 $17.8100 $15.1900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 35 35 17.605557 $427.4700 $24.2800
EXIT -EXIT COS Exit 2 2 3.000000 $150.0000 $50.0000
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 0.366667 $21.3100 $58.1200
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Subtotal (Total Children Is Unduplicated) 47 49 30.305557 $1012.3900 $33.4100
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 2 2 1.755556 $84.1600 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 5 6 4.605555 $23027.5000 $4999.9400
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 3.000000 $694.8600 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 17 22 14.142857 $707.1500 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 7 7 4.535714 $226.7900 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3 3 3.607143 $180.3600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 29 29 31.454763 $1572.7400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 17 19 4.827778 $241.3900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 42 42 41.626190 $2081.3100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.066666 $26.6700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 4.571429 $228.5700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 184 190 803.111902 $43368.1000 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 15 15 62.876189 $3395.3100 $54.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 79 95 399.265077 $4791.1900 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 36 37 234.033328 $19031.6100 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 24 24 107.257145 $8722.1600 $81.3200
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 4.857143 $394.9800 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 19 20 139.419045 $11337.5800 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 1 1 -13.200000 $-1073.4200 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 12 14 66.601587 $5416.0300 $81.3200
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 4.333333 $352.3800 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 31 33 132.157141 $10747.0200 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 34 35 137.787300 $11204.8800 $81.3200
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Subtotal (Total Children Is Unduplicated) 365 602 2193.692841 $146759.3200 $66.9000
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Total 666 2240.115064 $147771.7100 $65.9700
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Number of Children (Unduplicated) With at Least One Authorization 377