Summary Report for FSPSAs Initiated During the Report Period Center: 54
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 1715 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 15 15 12.493651 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 15 15 12.493651 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 3 3 3.111111 $363.4700 $116.8300
AACIS -92597TL AAC INTIAL EVAL BY LICENSED SLP 2 2 1.294444 $151.2200 $116.8300
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 102 115 103.388889 $5014.3600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 18 18 12.927779 $797.7800 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 2 2 1.044444 $15.8600 $15.1900
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.177778 $4.6300 $26.0400
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 35 35 26.183334 $635.7300 $24.2800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 3 2.188889 $69.6300 $31.8100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 1.000000 $49.5900 $49.5900
AUDE -92602 REPROGRAM COCHLEAR IMPLT <7 1 1 0.311111 $18.8900 $60.7300
AUDE -92651 AEP HEARING STATUS DETER I&R 2 2 7.080953 $554.0900 $78.2500
AUDE -V5010 ASSESSMENT FOR HEARING AID 22 22 7.405554 $335.6100 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.338889 $39.2500 $115.8100
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Subtotal (Total Children Is Unduplicated) 176 206 166.453175 $8050.1300 $48.3600
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 7 7 3.361111 $161.1300 $47.9400
AACFIT-92609TL AAC FITTING, ADJUST, TRAINING VISIT 1 1 0.377778 $18.1100 $47.9400
AACFIT-92609TLGT AAC FITTING, ADJUST, TRAINING VISIT 1 1 0.588889 $28.2300 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 51 58 89.877777 $449388.5000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 229 259 200.921033 $10046.0600 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 24 27 27.261904 $1363.1000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 58 68 78.223808 $3911.1900 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 1 1 0.005556 $0.2800 $50.4000
CONOF -CONOF CONSULT, OT, FACE TO FACE 120 123 139.496030 $6974.7700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 1.800000 $45.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 68 69 67.977771 $3398.8600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 152 163 170.123018 $8506.1500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 8 8 8.117459 $202.9400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 8 8 74.714286 $2017.2800 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 397 419 2019.690494 $109063.2100 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 16 16 88.285717 $4767.4300 $54.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1 1 2.142857 $25.7100 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 66 75 325.547620 $26473.5400 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 2 2 0.673015 $54.7300 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 6.714286 $546.0100 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 3 3 7.000000 $455.8400 $65.1200
OCCT -97530TL OT SESSION BY LICENSED OT 24 25 106.285716 $8643.1400 $81.3200
OCCT -97530TLGO OT SESSION BY LICENSED OT 2 2 3.000000 $243.9600 $81.3200
OCCT -97530TLHM OT SESSION BY OT ASST 5 5 13.500001 $879.1100 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 39 41 168.819046 $13728.3600 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 29 29 134.471430 $10935.2100 $81.3200
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.338889 $155.6300 $459.2400
SENS -V5264 EARMOLD 2 2 2.677778 $48.5500 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 60 67 358.595243 $29160.9500 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 5.714286 $464.6900 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 7 7 23.214286 $1887.7900 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 2 2 1.800000 $146.3800 $81.3200
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Subtotal (Total Children Is Unduplicated) 665 1494 4131.317084 $693741.8100 $167.9200
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Total 1715 4310.263910 $701791.9400 $162.8200
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Number of Children (Unduplicated) With at Least One Authorization 676