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 980 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
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 110 125 98.566670 $4780.5000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 2.261111 $139.5300 $61.7100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 4 4 4.633333 $112.5000 $24.2800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 0.344444 $10.9600 $31.8100
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.144444 $6.5400 $45.3100
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Subtotal (Total Children Is Unduplicated) 115 134 105.950002 $5050.0300 $47.6600
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 4 4 2.955555 $141.6900 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 38 42 65.605556 $328028.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 207 251 206.498810 $10324.9500 $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 4 4 11.928572 $322.0700 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 44 47 246.576192 $13315.1100 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 3 3 17.857143 $964.2800 $54.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 13 14 33.155556 $397.8700 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 7 7 40.576191 $3299.6700 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 3 3 8.166667 $664.1200 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 5 5 22.790476 $1853.3200 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 2 2 7.033333 $571.9500 $81.3200
SENS -V5264 EARMOLD 1 1 0.044444 $0.8100 $18.1100
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 16 17 22.749207 $1849.9600 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 1.142857 $92.9400 $81.3200
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Subtotal (Total Children Is Unduplicated) 410 838 1155.030568 $385144.2500 $333.4500
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Total 980 1266.845649 $390194.2800 $308.0000
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Number of Children (Unduplicated) With at Least One Authorization 428