Summary Report for FSPSAs Initiated During the Report Period Center: 10
This report shows the total number of units/fees for FSPSAs initiated during the report period.
(i.e., start 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 starting 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 2901 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 0.566667 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 2 0.566667 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 272 272 272.000000 $5837.1200 $21.4600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 261 261 261.000000 $4215.1500 $16.1500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 261 261 261.000000 $2067.1200 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 259 259 259.000000 $8238.7900 $31.8100
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 1.000000 $15.1900 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 255 255 255.000000 $5900.7000 $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 4 4 7.233333 $361.6700 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 29 32 32.000000 $1859.5200 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 4 5 5.000000 $290.5500 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 45 49 49.000000 $2847.3900 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 13.857143 $805.2400 $58.1100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 3 3 38.428571 $2233.0900 $58.1100
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Subtotal (Total Children Is Unduplicated) 344 1410 1459.519047 $35006.9800 $23.9900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 8 8 8.000000 $40000.0000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 96 110 158.352380 $7917.6200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 27 28 43.353967 $2167.7000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 17 19 21.150795 $1057.5500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 61 64 80.955555 $4047.7800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 600 698 4788.053188 $258554.9100 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 143 153 1062.857145 $86431.4900 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 170 188 942.261915 $76624.6700 $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 187 215 1297.250014 $105492.3000 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 2 2 1.682540 $136.8200 $81.3200
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Subtotal (Total Children Is Unduplicated) 875 1489 8407.917499 $582811.5100 $69.3200
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Total 2901 9868.003213 $617818.4900 $62.6100
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Number of Children (Unduplicated) With at Least One Authorization 912