Summary Report for FSPSAs Ending During the Report Period Center: 10
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 1299 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 2 2 0.733334 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 2 0.733334 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 23 25 25.000000 $536.5000 $21.4600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 17 19 19.000000 $306.8500 $16.1500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 17 19 19.000000 $150.4800 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 17 19 19.000000 $604.3900 $31.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 17 19 19.000000 $439.6600 $23.1400
NUTR -97802 NUTRITIONAL EVAL, INITIAL 6 6 5.600000 $280.0000 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 13 18 18.000000 $1045.9800 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 4 5 4.566667 $265.3700 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 18 18 18.000000 $1045.9800 $58.1100
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Subtotal (Total Children Is Unduplicated) 61 148 147.166667 $4675.2100 $31.7700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.000000 $10000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 1 1.000000 $50.0000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 213 254 254.890469 $12744.5000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 30 37 35.466667 $1773.3400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 55 61 48.611108 $2430.5400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 164 183 187.525395 $9376.2700 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 4.571429 $228.5700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 332 357 2148.604360 $116024.6200 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 64 70 381.550793 $31027.7000 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 64 71 359.145237 $29205.7200 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 100 112 731.309527 $59470.0700 $81.3200
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Subtotal (Total Children Is Unduplicated) 656 1149 4154.674985 $272331.3200 $65.5500
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Total 1299 4302.574986 $277006.5300 $64.3800
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Number of Children (Unduplicated) With at Least One Authorization 677