Summary Report for FSPSAs Ending During the Report Period Center: 06
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 2483 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 64 65 85.175397 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 64 65 85.175397 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 4 4.000000 $463.2400 $115.8100
EXIT -EXIT COS Exit 173 177 142.785714 $7139.2900 $50.0000
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 2 2 1.866666 $265.4900 $142.2200
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Subtotal (Total Children Is Unduplicated) 179 183 148.652380 $7868.0100 $52.9300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 20 20 34.179366 $2370.3400 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 3.400000 $235.7900 $69.3500
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 138 145 141.357786 $7067.8900 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 53 56 45.735238 $2286.7600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 56 57 31.149946 $778.7600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 11 11 15.244446 $762.2300 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 3 3 4.383333 $219.1700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 3 3.583333 $89.5800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 7 8 10.266667 $513.3400 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 3 3 1.922222 $96.1100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 3.883334 $97.0900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 0.333334 $16.6700 $50.0100
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.433333 $35.8300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 5 5 5.388889 $269.4500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.033333 $25.8300 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 18 24 313.714288 $7842.8500 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 7 8 147.428572 $3980.5700 $27.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 2.285714 $114.2900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 673 751 4788.357124 $258571.4800 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 41 44 230.142858 $12427.7300 $54.0000
INTR -T1013 INTERPRETER 56 72 302.647617 $15132.3800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 722 836 5322.542836 $63870.5600 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 22 27 147.619049 $12004.3800 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 4 4 11.821428 $961.3200 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 5 5 35.571428 $2316.4100 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 4 4 21.607142 $1407.0600 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 31 31 166.208731 $13516.1200 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 5 5 12.821429 $1042.6400 $81.3200
PHY -97110HM PT SESSION BY PT ASST 8 8 40.578571 $2642.4800 $65.1200
PHY -97110HMGT PT SESSION BY PT ASST 4 4 27.428571 $1786.1500 $65.1200
SENS -V5060 BEHIND EAR HEARING AID 4 4 4.000000 $918.4400 $229.6100
SENS -V5264 EARMOLD 14 14 31.901587 $578.3700 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 58 60 369.923809 $30082.2100 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 12 13 94.892857 $7716.6900 $81.3200
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Subtotal (Total Children Is Unduplicated) 860 2235 12375.788171 $456776.9500 $36.9100
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Total 2483 12609.615948 $464644.9600 $36.8500
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Number of Children (Unduplicated) With at Least One Authorization 925