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
Eligibility Filter: Program Patients
With the filters selected there were 1036 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 16 17 19.126984 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 16 17 19.126984 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 74 83 71.511113 $3468.3000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 7 7 6.755556 $416.8900 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 0.066667 $1.0100 $15.2000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 3.266667 $79.3200 $24.2800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 1.272222 $40.4700 $31.8100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 1.000000 $49.5900 $49.5900
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 0.655556 $51.3000 $78.2600
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 0.500000 $22.6600 $45.3200
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Subtotal (Total Children Is Unduplicated) 89 101 85.027781 $4129.5300 $48.5700
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 2 2 0.688889 $33.0300 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 31 34 54.555557 $272778.5000 $5000.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 242 292 245.091667 $12254.5900 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 12 14 14.194445 $709.7300 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 71 80 66.812697 $3340.6300 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 1 1 1.000000 $50.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 112 115 109.204768 $5460.2600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 1.155555 $28.8900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 75 78 84.042864 $4202.1700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 152 158 148.437300 $7421.8700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 8 5.369842 $134.2500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 69 75 274.660319 $14831.6600 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 5 5 21.285715 $1149.4300 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 13 14 90.719048 $7377.2800 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 1 1 0.700000 $56.9200 $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 10 11 54.500000 $4431.9400 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 1 1 0.333333 $27.1000 $81.3100
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 21 22 106.206349 $8636.6800 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 8.428571 $685.4100 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 5.642857 $458.8800 $81.3200
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Subtotal (Total Children Is Unduplicated) 466 918 1303.036125 $344829.6900 $264.6400
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Total 1036 1407.190890 $348959.2300 $247.9800
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Number of Children (Unduplicated) With at Least One Authorization 490