Summary Report for FSPSAs Ending During the Report Period Center: 01
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: 01-01-25 and 03-31-25 Date of Report: 04-06-25 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 5243 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 76 79 128.989684 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 76 79 128.989684 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 37 37 37.407458 $1814.2600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $61.7100 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 4 5 15.571429 $236.5300 $15.1900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.000000 $31.8100 $31.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 1.000000 $23.1400 $23.1400
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.000000 $45.3200 $45.3200
EXIT -EXIT COS Exit 111 124 108.080692 $5404.0300 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 5 10.000000 $750.0000 $75.0000
IPDEF -IPDEF_NM F/U PSYCH & DEV EVAL BY NON-MED PRO 1 1 2.000000 $111.0000 $55.5000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 3 6.000000 $359.5200 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 9 11 22.000000 $1781.5600 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 9 9 13.000000 $1052.7400 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 7 7 14.000000 $1133.7200 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 4 4 8.000000 $647.8400 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 5 5 7.500000 $607.3500 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 29 31 62.000000 $3715.0400 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 13 14 23.500000 $1408.1200 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 22 25 50.000000 $4049.0000 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 5 8 15.000000 $1214.7000 $80.9800
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 2.000000 $116.2200 $58.1100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 3 3 3.000000 $174.3300 $58.1100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 5.571429 $323.7500 $58.1100
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Subtotal (Total Children Is Unduplicated) 221 301 410.631008 $25177.9100 $61.3200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 18 20 16.761491 $83807.5000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 408 449 494.174041 $24708.6900 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 81 92 78.297949 $3914.8900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 56 57 53.991194 $1349.7800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 257 289 562.269044 $28113.4400 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 15 18 27.384919 $1369.2400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 6 6 5.688889 $142.2200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 100 108 208.969841 $10448.4900 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 7 7 15.000000 $750.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 7 8 9.650000 $241.2500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 92 94 164.344440 $8217.2000 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 8 8 12.400001 $620.0100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 8.499999 $212.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 151 159 279.492064 $13974.6100 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 10 10 16.877778 $843.8900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 9.666666 $241.6700 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 2 2 3.428571 $171.4300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 79 85 494.082536 $26680.4700 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 22 25 148.238091 $8004.8700 $54.0000
INTR -T1013 INTERPRETER 198 251 449.000001 $22450.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1103 1509 8585.218997 $103022.6200 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 5 21.571428 $1754.1900 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 17 18 108.857143 $8852.2600 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 2 2 23.857143 $1940.0700 $81.3200
SENS -V5264 EARMOLD 1 2 2.000000 $36.2600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 20 22 66.747620 $5427.9200 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 5.142857 $418.2200 $81.3200
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 5.142857 $334.9100 $65.1200
TRAV -TRAVS Travel by mile 1189 1607 8680.561856 $3862.8500 $0.4400
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Subtotal (Total Children Is Unduplicated) 1402 4863 20557.317416 $361911.4200 $17.6000
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Total 5243 21096.938108 $387089.3300 $18.3500
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Number of Children (Unduplicated) With at Least One Authorization 1502