Summary Report for FSPSAs Ending During the Report Period Center: 10
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
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2875 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 2 2 1.211112 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 2 2 1.211112 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 280 284 284.000000 $6094.6400 $21.4600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 275 279 279.000000 $4505.8500 $16.1500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 273 277 277.000000 $2193.8400 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 273 277 277.000000 $8811.3700 $31.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 272 276 276.000000 $6386.6400 $23.1400
NUTR -97802 NUTRITIONAL EVAL, INITIAL 5 5 7.233334 $361.6700 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 16 16 16.000000 $929.7600 $58.1100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 6 7 6.211111 $360.9300 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 24 28 29.142857 $1693.4900 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $58.1100 $58.1100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 1.000000 $58.1100 $58.1100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 320 1453 1455.587302 $31570.6300 $21.6900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 9 9 9.000000 $45000.0000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 107 119 108.726983 $5436.3400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 16 20 20.322224 $1016.1200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 22 22 17.400000 $870.0000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 76 82 78.100002 $3905.0100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 600 687 3822.865480 $206434.7900 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 112 121 767.857143 $62442.1300 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 153 171 879.030956 $71482.8800 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 160 186 928.321430 $75491.0700 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 3 3 2.968254 $241.3700 $81.3200
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 770 1420 6634.592472 $472319.7200 $71.1900
-------------------------------------------------------------------------------------------------------------------------------------
Total 2875 8091.390886 $503890.3500 $62.2700
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 815