Summary Report for FSPSAs Initiated During the Report Period Center: 03
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: 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 537 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 63 63 30.699996 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 63 63 30.699996 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 10 10 7.544444 $365.9000 $48.5000
OCTH -97167 OT EVAL HIGH COMPLEXITY 7 7 4.449999 $258.5800 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 11 11 6.127778 $356.0900 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 11 13 4.949999 $287.6400 $58.1100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 31 41 23.072220 $1268.2100 $54.9700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 5 5.000000 $25000.0000 $5000.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.189041 $43.7800 $231.5700
CONIF -CONIF CONSULT, ITDS FACE TO FACE 7 7 20.038096 $1001.9100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 69 77 86.200004 $4310.0200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 25 29 26.222223 $1311.1200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 51 57 70.741271 $3537.0700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 158 200 866.366681 $46783.7900 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 1.285714 $69.4300 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 11 12 45.261905 $3680.7000 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 15 18 67.895239 $5521.2400 $81.3200
SENS -V5261 BEHIND EAR DIGITAL BINAURAL HEARING 1 1 0.189041 $185.3600 $980.5300
SENS -V5264 EARMOLD 1 1 0.567123 $10.2800 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 18 24 59.814286 $4864.0900 $81.3200
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 277 433 1249.770624 $96318.7700 $77.0700
-------------------------------------------------------------------------------------------------------------------------------------
Total 537 1303.542840 $97586.9800 $74.8600
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 336