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: 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 901 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 3.622222 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 5 3.622222 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 53 63 47.472222 $2302.4000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 4 4 1.872222 $115.5300 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 0.377778 $5.7400 $15.1900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 2.122222 $51.5300 $24.2800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.244444 $7.7700 $31.8000
AUDE -V5010 ASSESSMENT FOR HEARING AID 5 5 2.072222 $93.9100 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 1.622222 $187.8700 $115.8100
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Subtotal (Total Children Is Unduplicated) 63 78 55.783332 $2764.7500 $49.5600
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 2 2 2.044445 $98.0100 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 16 16 24.749999 $123749.5000 $4999.9800
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 9.857143 $683.5900 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 2.000000 $463.2400 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 222 262 217.268256 $10863.4200 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 19 20 18.911110 $945.5500 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 48 51 50.007935 $2500.4000 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 1 1 0.238889 $11.9500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 101 102 91.877778 $4593.8900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 0.416667 $10.4200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 71 75 95.949204 $4797.4600 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 2 2 2.000000 $100.0000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 145 152 131.234124 $6561.6900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 1.527778 $38.2000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 65 65 342.290472 $18483.7000 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 5 5 24.000001 $1295.9900 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 8 8 20.723809 $1685.2800 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 1 1 4.000000 $325.2800 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 1 1 2.000000 $130.2400 $65.1200
OCCT -97530TL OT SESSION BY LICENSED OT 3 3 12.571428 $1022.3100 $81.3200
OCCT -97530TLGO OT SESSION BY LICENSED OT 2 3 10.600000 $861.9900 $81.3200
OCCT -97530TLHM OT SESSION BY OT ASST 1 1 10.000000 $651.2000 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 9 9 6.928571 $563.4500 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 1 1 6.714286 $546.0100 $81.3200
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 3.000000 $243.9600 $81.3200
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 2 2.622222 $1204.1700 $459.2200
SENS -V5264 EARMOLD 2 2 3.765079 $68.2600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 19 19 57.869840 $4705.9700 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 12.476190 $1014.5600 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 -42.714286 $-3473.5300 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 1.642857 $133.6000 $81.3200
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Subtotal (Total Children Is Unduplicated) 434 818 1127.573797 $184949.1200 $164.0200
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Total 901 1186.979351 $187713.8700 $158.1400
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Number of Children (Unduplicated) With at Least One Authorization 439