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 1149 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 -92552 PURE TONE AUDIOMETRY -AIR ONLY 32 33 33.000000 $708.1800 $21.4600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 30 31 31.000000 $500.6500 $16.1500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 30 31 31.000000 $245.5200 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 30 31 31.000000 $986.1100 $31.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 30 31 31.000000 $717.3400 $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 7 10.088888 $504.4400 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 9 13 13.000000 $755.4300 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 14 15 15.000000 $871.6500 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 3.571429 $207.5300 $58.1100
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Subtotal (Total Children Is Unduplicated) 59 196 201.660317 $5716.0900 $28.3500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.000000 $10000.0000 $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 323 383 2157.879378 $116525.4600 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 44 47 309.750002 $25188.8500 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 45 51 241.285715 $19621.3300 $81.3200
SENS -V5264 EARMOLD 1 1 1.000000 $18.1300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 64 67 382.392857 $31096.1700 $81.3200
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Subtotal (Total Children Is Unduplicated) 554 948 3474.693676 $221469.2800 $63.7400
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Total 1149 3678.198438 $227185.3800 $61.7700
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Number of Children (Unduplicated) With at Least One Authorization 565