Summary Report for FSPSAs Ending During the Report Period Center: 06
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 2022 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 61 61 54.564284 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 61 61 54.564284 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 5 8.000000 $926.4800 $115.8100
EXIT -EXIT COS Exit 131 131 131.000000 $6550.0000 $50.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $119.8400 $59.9200
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Subtotal (Total Children Is Unduplicated) 136 137 141.000000 $7596.3200 $53.8700
EI Services, Class # 03
AUD -92630 AUD REHAB PRELING HEARING LOSS 27 29 44.385716 $3078.1600 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 2.166667 $150.2600 $69.3500
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 125 131 110.715078 $5535.7600 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 74 77 59.901294 $2995.0600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 43 44 40.583137 $1014.5900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 7 7 12.294444 $614.7200 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 5 5 12.266667 $613.3400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 0.766666 $19.1700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 5 5 6.494443 $324.7200 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 3 3 4.333334 $216.6700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 1.850000 $46.2500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 4 4 5.966666 $298.3300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 5 5 7.099999 $355.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 2.350000 $58.7500 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 20 21 503.714286 $12592.8600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 525 571 3578.080955 $193216.3400 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 30 32 207.500000 $11205.0000 $54.0000
INTR -T1013 INTERPRETER 96 133 380.442857 $19022.1500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 555 622 3901.828572 $46821.9300 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 14 15 73.133333 $5947.2000 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 11.428572 $929.3700 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 1 1 1.857143 $120.9300 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 2 2 3.857142 $251.1800 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 23 24 168.714286 $13719.8300 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 5 5 19.228572 $1563.6600 $81.3200
PHY -97110HM PT SESSION BY PT ASST 5 6 42.428571 $2762.9400 $65.1200
PHY -97110HMGT PT SESSION BY PT ASST 3 3 4.285714 $279.0800 $65.1200
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 2.000000 $229.6200 $114.8100
SENS -V5060 BEHIND EAR HEARING AID 4 4 6.000000 $1377.6600 $229.6100
SENS -V5264 EARMOLD 18 19 39.057143 $708.1100 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 35 36 236.657143 $19244.9500 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 10 10 55.785715 $4536.4900 $81.3200
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Subtotal (Total Children Is Unduplicated) 719 1824 9547.174115 $349850.0600 $36.6400
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Total 2022 9742.738399 $357446.3800 $36.6900
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Number of Children (Unduplicated) With at Least One Authorization 786