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 1038 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 14 14 11.815873 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 14 14 11.815873 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AACIS -92597TL AAC INTIAL EVAL BY LICENSED SLP 1 1 1.000000 $116.8300 $116.8300
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 100 113 101.388889 $4917.3600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 8 8 6.455556 $398.3800 $61.7100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 1.866666 $45.3200 $24.2800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 1.188889 $37.8200 $31.8100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 1.000000 $49.5900 $49.5900
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 0.366667 $28.6900 $78.2600
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 0.933333 $42.3000 $45.3200
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Subtotal (Total Children Is Unduplicated) 115 132 114.200000 $5636.2900 $49.3500
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 1 1 0.477778 $22.9100 $47.9400
AACFIT-92609TL AAC FITTING, ADJUST, TRAINING VISIT 1 1 0.377778 $18.1100 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 38 43 69.922222 $349611.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 229 258 199.921033 $9996.0600 $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
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 67 69 283.226988 $15294.2100 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 4 4 29.428572 $1589.1400 $54.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1 1 2.142857 $25.7100 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 14 15 59.866667 $4868.3600 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 1 1 0.244444 $19.8700 $81.3100
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 2.571429 $209.1100 $81.3200
OCCT -97530TLGO OT SESSION BY LICENSED OT 1 1 1.000000 $81.3200 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 12 12 51.604761 $4196.4900 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 2 2 9.033333 $734.5900 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 21 22 110.549210 $8989.8400 $81.3200
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Subtotal (Total Children Is Unduplicated) 464 892 1313.372618 $420059.0000 $319.8300
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Total 1038 1439.388491 $425695.2900 $295.7500
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Number of Children (Unduplicated) With at Least One Authorization 490