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: 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 1537 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 5 5 5.633334 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 5 5.633334 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 1 1 1.000000 $116.8300 $116.8300
AACIS -92597TL AAC INTIAL EVAL BY LICENSED SLP 1 1 1.000000 $116.8300 $116.8300
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 105 117 113.689682 $5513.9500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 17 18 12.572223 $775.8400 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 5 5 1.572222 $23.8800 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.400000 $8.5800 $21.4600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.272222 $7.0900 $26.0400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.400000 $6.4600 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 24 24 18.800002 $456.4700 $24.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.400000 $3.1700 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 3 2.372222 $75.4600 $31.8100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 1.000000 $49.5900 $49.5900
AUDE -92602 REPROGRAM COCHLEAR IMPLT <7 1 1 0.461111 $28.0000 $60.7300
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 3.571429 $279.4600 $78.2500
AUDE -V5010 ASSESSMENT FOR HEARING AID 17 17 4.505557 $204.2000 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 0.566667 $65.6300 $115.8200
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Subtotal (Total Children Is Unduplicated) 160 195 162.583337 $7731.4400 $47.5500
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 1 1 0.266667 $12.7900 $47.9500
AACFIT-92609TL AAC FITTING, ADJUST, TRAINING VISIT 1 1 0.677778 $32.4900 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 31 33 36.755555 $183777.5000 $4999.9900
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 0.888889 $205.8900 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 222 264 209.433336 $10471.6800 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 18 19 19.477777 $973.8900 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 52 58 43.438097 $2171.9100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 110 111 113.395236 $5669.7600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.466667 $11.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 59 60 45.167462 $2258.3800 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 2 2 2.000000 $100.0000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 141 150 167.652385 $8382.6600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 7 3.655555 $91.3900 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 6 7 61.714284 $1666.2900 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 367 383 1759.661898 $95021.8100 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 20 20 105.999998 $5724.0100 $54.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1 1 0.600000 $7.2000 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 47 51 197.439682 $16055.8200 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 1 2 4.071428 $265.1400 $65.1200
OCCT -97530TL OT SESSION BY LICENSED OT 28 29 125.723809 $10223.9000 $81.3200
OCCT -97530TLGO OT SESSION BY LICENSED OT 4 4 26.999999 $2195.6400 $81.3200
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 4.400000 $357.8100 $81.3200
OCCT -97530TLHM OT SESSION BY OT ASST 2 2 12.285714 $800.0500 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 26 27 122.423808 $9955.5200 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 2 2 15.857142 $1289.5100 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 25 26 90.057142 $7323.4700 $81.3200
SENS -V5060 BEHIND EAR HEARING AID 1 1 0.166667 $38.2800 $229.6600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 3 4 5.200000 $2387.9400 $459.2200
SENS -V5264 EARMOLD 5 6 7.722222 $140.0000 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 48 51 232.971424 $18945.2600 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 9 9 55.152380 $4484.9900 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 2 2 4.533334 $368.6600 $81.3200
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Subtotal (Total Children Is Unduplicated) 627 1337 3476.256335 $391411.2900 $112.6000
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Total 1537 3644.473006 $399142.7300 $109.5200
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Number of Children (Unduplicated) With at Least One Authorization 632