Summary Report for FSPSAs Ending During the Report Period Center: 04
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: 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 2253 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 52 53 25.169838 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 52 53 25.169838 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 0.033333 $1.6200 $48.4500
AUD -92626 EVAL OF AUD REHAB STATUS 3 3 3.000000 $185.1300 $61.7100
OCTH -97165TL OT EVAL LOW COMPLEXITY 2 2 0.900000 $52.3000 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 81 89 21.153970 $1229.2700 $58.1100
PSTH -97161TL PT EVAL LOW COMPLEXITY 1 1 0.061111 $3.5500 $58.1000
PSTH -97163TL PT EVAL HIGH COMPLEXITY 50 55 14.311110 $831.6100 $58.1100
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 1.000000 $15.1100 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 1 2 0.311111 $18.0800 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 59 62 16.383334 $952.0400 $58.1100
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 0.077778 $4.5200 $58.1300
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 0.500000 $29.0600 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 12.857143 $747.1300 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 12.857143 $747.1300 $58.1100
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Subtotal (Total Children Is Unduplicated) 133 221 83.446033 $4816.5300 $57.7200
EI Services, Class # 03
AUDE -V5160 DISPENSING FEE BINAURAL 4 4 4.000000 $926.4800 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 16 54 12.822222 $641.1100 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5 5 2.366667 $118.3400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 6 6 1.909523 $95.4800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1 1 0.766667 $38.3400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 5 5 0.544445 $27.2300 $50.0100
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 138 183 901.857123 $24350.1900 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 659 699 4883.266659 $263696.4400 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 2 1.857143 $100.2900 $54.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 660 709 4956.265077 $59475.1900 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 6.142857 $499.5400 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 98 116 628.785716 $51132.8900 $81.3200
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 0.285714 $23.2300 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 1 1 6.000000 $487.9200 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 69 84 471.571432 $38348.2200 $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 3.214286 $261.3900 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 87 103 537.928574 $43744.3900 $81.3200
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Subtotal (Total Children Is Unduplicated) 823 1979 12422.584105 $484462.1200 $39.0000
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Total 2253 12531.199976 $489278.6500 $39.0400
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Number of Children (Unduplicated) With at Least One Authorization 865