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 940 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 -92597TL AAC INTIAL EVAL BY LICENSED SLP 1 1 1.000000 $116.8300 $116.8300
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 101 113 105.261111 $5105.1600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 4 4 2.500000 $154.2800 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 3 3 0.655555 $9.9600 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.400000 $8.5800 $21.4600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.400000 $6.4600 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 2.672222 $64.8800 $24.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.400000 $3.1700 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 1.372222 $43.6500 $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 3.571429 $279.4600 $78.2500
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.400000 $18.1300 $45.3200
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Subtotal (Total Children Is Unduplicated) 111 132 119.632539 $5860.1500 $48.9800
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 21 23 28.111111 $140555.5000 $5000.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.400000 $92.6500 $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
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 54 57 269.833333 $14571.0100 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 4 4 27.285714 $1473.4300 $54.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1 1 0.600000 $7.2000 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 9 9 36.490478 $2967.4100 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 0.400000 $32.5300 $81.3200
OCCT -97530TLGO OT SESSION BY LICENSED OT 2 2 15.928571 $1295.3100 $81.3200
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 4.400000 $357.8100 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 8 9 45.099999 $3667.5400 $81.3200
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.800000 $367.3800 $459.2200
SENS -V5264 EARMOLD 2 2 2.288889 $41.5000 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 18 18 61.585712 $5008.1600 $81.3200
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Subtotal (Total Children Is Unduplicated) 438 803 1098.854767 $200614.0200 $182.5700
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Total 940 1224.120640 $206474.1700 $168.6700
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Number of Children (Unduplicated) With at Least One Authorization 449