Summary Report for FSPSAs Ending During the Report Period Center: 54
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 1605 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 8 8 5.865079 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 8 8 5.865079 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 1 1 1.000000 $116.8300 $116.8300
AACIS -92597TL AAC INTIAL EVAL BY LICENSED SLP 1 1 0.216667 $25.3200 $116.8500
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 112 128 100.744448 $4886.1200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 12 12 10.066666 $621.2100 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 2 2 1.272222 $19.3200 $15.1900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 27 29 22.444445 $544.9500 $24.2800
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 0.255556 $2.7800 $10.8800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 3 0.800000 $25.4500 $31.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 1.000000 $23.1400 $23.1400
AUDE -92602 REPROGRAM COCHLEAR IMPLT <7 1 1 0.200000 $12.1500 $60.7300
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 0.166667 $13.0400 $78.2700
AUDE -V5010 ASSESSMENT FOR HEARING AID 17 17 5.861109 $265.6200 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 0.255555 $29.5900 $115.7900
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Subtotal (Total Children Is Unduplicated) 159 199 144.283335 $6585.5200 $45.6400
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 11 11 7.194443 $344.8900 $47.9400
AACFIT-92609TL AAC FITTING, ADJUST, TRAINING VISIT 2 2 0.561111 $26.9000 $47.9400
AACFIT-92609TLGT AAC FITTING, ADJUST, TRAINING VISIT 1 1 0.433333 $20.7700 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 53 60 87.224603 $436123.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 207 252 207.498810 $10374.9500 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 23 26 26.928571 $1346.4300 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 54 58 64.996036 $3249.8200 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 1 1 0.005556 $0.2800 $50.4000
CONIP -CONIP CONSULT, ITDS PHONE 1 2 1.155556 $28.8900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 98 103 127.426189 $6371.3200 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 2 2 6.563492 $328.1800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 69 70 71.410318 $3570.5100 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 1 1 0.777778 $38.8900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 161 170 166.642069 $8332.1100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 2.044444 $51.1100 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 13 15 38.471427 $1038.7300 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 335 366 1830.390478 $98841.1300 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 10 11 62.357143 $3367.2800 $54.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 13 14 33.155556 $397.8700 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 63 68 346.853968 $28206.2000 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 4 4 13.738096 $1117.1800 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 30 33 147.361904 $11983.4900 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 25 26 98.184127 $7984.3200 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 22 23 121.104762 $9848.2500 $81.3200
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.122222 $56.1200 $459.1400
SENS -V5264 EARMOLD 4 4 2.380952 $43.1700 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 52 56 216.750795 $17626.1500 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 1.142857 $92.9400 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 0.714286 $46.5200 $65.1200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 8 9 39.471430 $3209.8200 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 3 3 14.142858 $1150.0900 $81.3200
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Subtotal (Total Children Is Unduplicated) 592 1398 3737.205170 $655217.3000 $175.3200
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Total 1605 3887.353584 $661802.8300 $170.2500
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Number of Children (Unduplicated) With at Least One Authorization 600