Summary Report for FSPSAs Initiated During the Report Period Center: 10
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 4756 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 5 5 1.844445 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 5 1.844445 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 2 2 2.000000 $30.3800 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 420 432 432.000000 $9270.7200 $21.4600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 408 417 417.000000 $6734.5500 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.000000 $24.2800 $24.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 405 414 414.000000 $3278.8800 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 405 414 414.000000 $13169.3400 $31.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 407 416 416.000000 $9626.2400 $23.1400
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.000000 $45.3200 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.000000 $115.8100 $115.8100
NUTR -97802 NUTRITIONAL EVAL, INITIAL 7 8 12.422221 $621.1100 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 47 58 63.420635 $3685.3800 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 7 7 7.000000 $406.7700 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 64 71 69.622222 $4045.7500 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 3 3 14.285715 $830.1400 $58.1100
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Subtotal (Total Children Is Unduplicated) 516 2245 2264.750793 $51884.6600 $22.9100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 9 11 11.000000 $55000.0000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 180 196 207.719053 $10385.9800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 37 39 41.166668 $2058.3400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 33 34 16.033335 $801.6800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 121 128 115.466668 $5773.3400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 882 1071 6030.648471 $325654.9400 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 256 294 1732.550010 $140890.9000 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 281 319 1444.599999 $117474.7800 $81.3200
SENS -V5264 EARMOLD 2 2 2.000000 $36.2600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 359 411 2020.486517 $164305.8700 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 6.285714 $511.1500 $81.3200
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Subtotal (Total Children Is Unduplicated) 1319 2506 11627.956435 $822893.2300 $70.7700
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Total 4756 13894.551673 $874777.8900 $62.9600
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Number of Children (Unduplicated) With at Least One Authorization 1352