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
Eligibility Filter: Program Patients
With the filters selected there were 4401 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
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Subtotal (Total Children Is Unduplicated) 2 2 1.211112 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 1.000000 $15.1900 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 411 417 417.000000 $8948.8200 $21.4600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 404 409 409.000000 $6605.3500 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.000000 $24.2800 $24.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 401 406 406.000000 $3215.5200 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 401 406 406.000000 $12914.8600 $31.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 400 405 405.000000 $9371.7000 $23.1400
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.000000 $45.3200 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.000000 $115.8100 $115.8100
NUTR -97802 NUTRITIONAL EVAL, INITIAL 9 10 10.694446 $534.7300 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 41 45 45.000000 $2614.9500 $58.1100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 8 9 8.211111 $477.1500 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 50 60 61.142857 $3553.0100 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 2.000000 $116.2200 $58.1100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 5 5 26.785714 $1556.5200 $58.1100
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Subtotal (Total Children Is Unduplicated) 492 2180 2202.834128 $50225.6500 $22.8000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 15 16 16.000000 $80000.0000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 162 182 198.647620 $9932.3800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 32 38 43.146032 $2157.3000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 27 28 27.844444 $1392.2200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 125 134 129.305558 $6465.2900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 865 973 5679.328964 $306683.8200 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 204 226 1342.892855 $109204.0400 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 254 282 1409.147623 $114591.9600 $81.3200
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 1.000000 $114.8100 $114.8100
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 1.000000 $229.6100 $229.6100
SENS -V5264 EARMOLD 2 2 2.000000 $36.2600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 289 333 1785.500004 $145196.8700 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 3 3 2.968254 $241.3700 $81.3200
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Subtotal (Total Children Is Unduplicated) 1166 2219 10638.781354 $776245.9400 $72.9600
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Total 4401 12842.826594 $826471.5900 $64.3500
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Number of Children (Unduplicated) With at Least One Authorization 1235