Summary Report for FSPSAs Ending During the Report Period Center: 03
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: 10-01-24 and 12-31-24 Date of Report: 03-31-25 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 1212 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 70 72 31.555554 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 70 72 31.555554 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 16 18 17.444444 $846.0500 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 1.322222 $42.0600 $31.8100
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 0.280822 $32.5200 $115.8000
OCTH -97165 OT EVAL LOW COMPLEXITY 4 5 1.611111 $93.6200 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 33 35 28.454687 $1653.5100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 52 55 25.277776 $1468.8800 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 0.072222 $4.2000 $58.0900
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.216667 $12.5900 $58.1200
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 82 91 41.444445 $2408.3400 $58.1100
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Subtotal (Total Children Is Unduplicated) 167 211 117.124396 $6619.8800 $56.5200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 18 19 14.069179 $70346.5000 $5000.0400
CONIF -CONIF CONSULT, ITDS FACE TO FACE 8 8 7.822223 $391.1200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 54 59 61.657143 $3082.8600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 39 39 41.111113 $2055.5700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 74 79 82.100002 $4105.0100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 403 477 1845.698389 $99667.7700 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 2 13.142857 $709.7200 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 39 47 166.328569 $13525.8600 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 74 80 268.023810 $21795.7200 $81.3200
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.024658 $5.6700 $230.0000
SENS -V5264 EARMOLD 2 2 0.205480 $3.7300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 103 116 443.107933 $36033.5300 $81.3200
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Subtotal (Total Children Is Unduplicated) 618 929 2943.291356 $251723.0400 $85.5200
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Total 1212 3091.971306 $258342.9200 $83.5500
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Number of Children (Unduplicated) With at Least One Authorization 689