Summary Report for FSPSAs Initiated During the Report Period Center: 03
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: 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 1150 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 66 68 52.407939 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 66 68 52.407939 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 13 14 12.194445 $591.4300 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 7 7 4.596575 $146.2200 $31.8100
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 0.128767 $14.9000 $115.7500
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.227778 $13.2400 $58.1200
OCTH -97167 OT EVAL HIGH COMPLEXITY 38 41 19.061112 $1107.6500 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 3 3 1.305556 $75.8700 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 49 53 30.194446 $1754.6100 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 0.438889 $25.5000 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.127778 $7.4300 $58.1200
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 76 81 37.822222 $2197.8500 $58.1100
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Subtotal (Total Children Is Unduplicated) 162 204 106.097568 $5934.7000 $55.9400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 12 13 10.721766 $53609.0000 $5000.0200
CONIF -CONIF CONSULT, ITDS FACE TO FACE 10 10 13.600001 $680.0100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 56 62 80.877782 $4043.9100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 27 28 44.788888 $2239.4400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 62 64 89.099998 $4454.9900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 336 462 2000.104760 $108005.6300 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 3 3 22.000000 $1188.0100 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 43 52 257.668253 $20953.5800 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 57 73 367.184920 $29859.5000 $81.3200
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 0.128767 $29.5500 $229.4900
SENS -V5264 EARMOLD 2 2 0.128767 $2.3300 $18.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 86 107 448.938092 $36507.6300 $81.3200
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Subtotal (Total Children Is Unduplicated) 518 878 3335.241994 $261573.5800 $78.4300
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Total 1150 3493.747501 $267508.2700 $76.5700
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Number of Children (Unduplicated) With at Least One Authorization 582