Summary Report for FSPSAs Ending During the Report Period Center: 03
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 1190 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 70 47.444448 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 66 70 47.444448 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 14 15 13.005555 $630.7700 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.000000 $31.8100 $31.8100
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 0.200000 $11.6200 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 48 55 35.581747 $2067.6600 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 43 45 20.877778 $1213.2100 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.094444 $5.4900 $58.0800
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $58.1100 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 70 76 36.244436 $2106.1200 $58.1100
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Subtotal (Total Children Is Unduplicated) 165 197 109.003960 $6182.8900 $56.7200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 12 12 10.600000 $53000.0000 $5000.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.057534 $13.3200 $231.4800
CONIF -CONIF CONSULT, ITDS FACE TO FACE 9 9 8.622223 $431.1200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 69 73 88.422225 $4421.1300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 46 49 56.766667 $2838.3400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 83 87 118.241269 $5912.0600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 411 463 1958.733326 $105771.6400 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 3 3 19.142857 $1033.7100 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 55 67 274.812700 $22347.7800 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 56 63 260.457139 $21180.3900 $81.3200
SENS -V5261 BEHIND EAR DIGITAL BINAURAL HEARING 1 1 0.057534 $56.3900 $980.1600
SENS -V5264 EARMOLD 1 1 0.172603 $3.1300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 84 94 385.071423 $31314.0200 $81.3200
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Subtotal (Total Children Is Unduplicated) 611 923 3181.157500 $248323.0200 $78.0600
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Total 1190 3337.605908 $254505.9100 $76.2500
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Number of Children (Unduplicated) With at Least One Authorization 674