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 1078 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 -92552 PURE TONE AUDIOMETRY -AIR ONLY 33 33 33.000000 $708.1800 $21.4600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 31 31 31.000000 $500.6500 $16.1500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 31 31 31.000000 $245.5200 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 31 31 31.000000 $986.1100 $31.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 31 31 31.000000 $717.3400 $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 9 9.927779 $496.4000 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 12 14 14.000000 $813.5400 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.211111 $12.2700 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 12 14 14.000000 $813.5400 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 5.571429 $323.7500 $58.1100
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Subtotal (Total Children Is Unduplicated) 62 198 202.710319 $5778.4300 $28.5100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 4.000000 $20000.0000 $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 328 353 2286.798404 $123487.1200 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 32 34 227.464287 $18497.3800 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 36 39 298.221428 $24251.3600 $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 1 1 1.000000 $18.1300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 57 63 443.178576 $36039.2400 $81.3200
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Subtotal (Total Children Is Unduplicated) 498 878 3661.606349 $242584.8500 $66.2500
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Total 1078 3865.527780 $248363.2700 $64.2500
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Number of Children (Unduplicated) With at Least One Authorization 514