Summary Report for FSPSAs Initiated During the Report Period Center: 01
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: 07-01-24 and 09-30-24 Date of Report: 04-06-25 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 5242 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 97 99 139.990483 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 97 99 139.990483 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 34 35 36.380344 $1764.4500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 2.000000 $123.4200 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 2 2 2.000000 $30.3800 $15.1900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.000000 $31.8100 $31.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 1.000000 $23.1400 $23.1400
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.000000 $45.3200 $45.3200
EXIT -EXIT COS Exit 143 148 107.307635 $5365.3700 $50.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 3 6.000000 $359.5200 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 1 2.000000 $119.8400 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 7 7 14.000000 $1133.7200 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 6 6 11.000000 $890.7800 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 7 8 16.000000 $1295.6800 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 3 3 6.000000 $485.8800 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 6 6 12.000000 $971.7600 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 3 3 6.000000 $485.8800 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 36 38 75.000000 $4494.0000 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 13 14 27.000000 $1617.8400 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 27 31 61.000000 $4939.7800 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 9 10 20.000000 $1619.6000 $80.9800
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 3 3 3.000000 $174.3300 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 7.714286 $448.2800 $58.1100
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Subtotal (Total Children Is Unduplicated) 253 328 421.402265 $26653.2200 $63.2500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 14 14 13.100000 $65500.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 389 435 467.287819 $23364.3900 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 55 60 47.294524 $2364.7100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 39 40 40.037444 $1000.9400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 274 289 515.233327 $25761.6300 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 18 20 16.048412 $802.4200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.350000 $8.7500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 105 109 201.242057 $10062.0700 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 5 5 17.047620 $852.3900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 5 6 9.600000 $240.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 105 106 160.766664 $8038.3200 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 7 7 8.666667 $433.3400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 1.966667 $49.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 181 187 304.454755 $15222.7000 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 11 13 5.172222 $258.6100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 5.483333 $137.0800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 79 83 506.961912 $27375.9700 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 28 28 188.166667 $10161.0000 $54.0000
INTR -T1013 INTERPRETER 217 293 518.861906 $25943.1000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1154 1495 8567.322667 $102807.8800 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 7 7 52.571430 $4275.1100 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 17 17 107.180955 $8715.9400 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 3 4 18.428572 $1498.6100 $81.3200
SENS -V5264 EARMOLD 1 1 1.000000 $18.1300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 23 25 134.823811 $10963.8900 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 13.000000 $1057.1600 $81.3200
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 6.857143 $446.5300 $65.1200
TRAN -TRAN *FAMILY TRANSPORTATION 1 1 2.000000 $200.0000 $100.0000
TRAV -TRAVS Travel by mile 1179 1560 8599.408381 $3826.7500 $0.4500
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Subtotal (Total Children Is Unduplicated) 1336 4815 20530.334955 $351386.5700 $17.1200
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Total 5242 21091.727703 $378039.7800 $17.9200
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Number of Children (Unduplicated) With at Least One Authorization 1525