Summary Report for FSPSAs Ending During the Report Period Center: 09
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 2315 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 31 31 34.642858 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 31 31 34.642858 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.400000 $8.5800 $21.4600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.400000 $10.4200 $26.0400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.400000 $6.4600 $16.1500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.400000 $3.1700 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.400000 $12.7200 $31.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.400000 $9.2600 $23.1400
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 0.400000 $31.3000 $78.2500
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.400000 $18.1300 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.400000 $46.3200 $115.8100
NUTR -97802 NUTRITIONAL EVAL, INITIAL 8 9 37.195238 $1859.7700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 19 22 93.947621 $4697.3900 $50.0000
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 2.000000 $116.2200 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 25 27 162.285712 $9430.4300 $58.1100
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Subtotal (Total Children Is Unduplicated) 49 68 299.028571 $16250.1600 $54.3400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 5 3.177778 $15889.0000 $5000.0300
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 204 329 413.400807 $20670.0700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 105 126 125.169332 $3129.2300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 143 149 120.161902 $6008.0900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 3 3.000000 $75.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 73 75 61.783333 $3089.1700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 48 49 38.499999 $1925.0000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 95 101 92.800000 $4640.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 809 914 5397.771424 $291479.6900 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 99 113 617.485712 $50213.9600 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 12 13 102.857144 $6698.0500 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 132 143 874.289681 $71097.2300 $81.3200
PHY -97110HM PT SESSION BY PT ASST 1 1 5.714286 $372.1200 $65.1200
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.400000 $91.8400 $229.6100
SENS -V5264 EARMOLD 1 1 0.400000 $7.2500 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 177 192 1233.161906 $100280.7100 $81.3200
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Subtotal (Total Children Is Unduplicated) 986 2216 9091.073304 $575691.4000 $63.3200
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Total 2315 9424.744733 $591941.5600 $62.8100
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Number of Children (Unduplicated) With at Least One Authorization 1012