Summary Report for FSPSAs Initiated During the Report Period Center: 06
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 1628 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 70.826193 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 52 53 70.826193 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.000000 $115.8100 $115.8100
EXIT -EXIT COS Exit 172 175 139.785714 $6989.2900 $50.0000
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Subtotal (Total Children Is Unduplicated) 173 176 140.785714 $7105.1000 $50.4700
EI Services, Class # 03
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 1.311111 $90.9200 $69.3500
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 138 143 125.463342 $6273.1700 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 56 57 57.191588 $2859.5900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 56 56 33.515223 $837.8900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 9 9 6.327777 $316.3900 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 7 8 9.100000 $455.0000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 7 7 9.221428 $230.5300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 4 4 4.311111 $215.5600 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 7 7 10.600000 $530.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 2.133333 $53.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 3 3 5.500000 $275.0000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 4.666666 $116.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 5 6 5.549999 $277.5000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 2.033333 $50.8300 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 28.571429 $714.2900 $25.0000
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 234 265 1671.580971 $90265.3800 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 14 16 90.566669 $4890.6000 $54.0000
INTR -T1013 INTERPRETER 57 76 418.038095 $20901.9000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 614 719 4541.809577 $54501.7200 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 14.857143 $1208.1800 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 2 2 0.535714 $43.5700 $81.3300
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $229.6100 $229.6100
SENS -V5264 EARMOLD 1 1 1.666667 $30.2200 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4 5 8.000000 $650.5700 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 9.285714 $755.1100 $81.3200
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Subtotal (Total Children Is Unduplicated) 677 1399 7065.122604 $186887.8000 $26.4500
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Total 1628 7276.734511 $193992.8900 $26.6600
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Number of Children (Unduplicated) With at Least One Authorization 872