Summary Report for FSPSAs Ending During the Report Period Center: 54
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 673 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 14 15 17.760317 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 14 15 17.760317 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 51 58 51.972224 $2520.6600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 4 4 5.000000 $308.5500 $61.7100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.566667 $13.7600 $24.2800
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 0.305556 $13.8500 $45.3300
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Subtotal (Total Children Is Unduplicated) 56 65 57.844447 $2856.8200 $49.3900
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 1 1 0.555556 $26.6400 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 21 24 36.422223 $182111.5000 $5000.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 164 190 157.013889 $7850.7000 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 10 12 10.977778 $548.8900 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 50 57 50.373014 $2518.6400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 80 82 75.629370 $3781.4900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 1.155555 $28.8900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 50 53 40.455561 $2022.7900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 111 114 110.679365 $5533.9800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 7 3.155556 $78.8900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 30 32 112.969842 $6100.3700 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 4 4 18.571429 $1002.8600 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 3 3 20.785714 $1690.3000 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 2 2 6.720635 $546.5300 $81.3200
OCCT -97530TLHM OT SESSION BY OT ASST 1 1 3.285714 $213.9600 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 3 3 8.523810 $693.1600 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 6 6 27.057143 $2200.2800 $81.3200
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Subtotal (Total Children Is Unduplicated) 307 593 684.332154 $216949.8500 $317.0200
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Total 673 759.936918 $219806.6700 $289.2400
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Number of Children (Unduplicated) With at Least One Authorization 327