Summary Report for FSPSAs Initiated During the Report Period Center: 54
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 954 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 13 13 13.588890 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 13 13 13.588890 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 1 1 1.000000 $116.8300 $116.8300
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 47 54 46.107143 $2236.1900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 1.377778 $85.0200 $61.7100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 6.000000 $145.6800 $24.2800
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 1.272222 $57.6600 $45.3200
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Subtotal (Total Children Is Unduplicated) 54 62 55.757143 $2641.3800 $47.3700
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 2 2 0.788889 $37.8200 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 16 16 18.138888 $90694.0000 $4999.9800
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $231.6200 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 226 266 239.565475 $11978.2700 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 10 12 11.850000 $592.5000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 0.272222 $6.8100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 69 86 93.669840 $4683.4900 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 1 1 1.000000 $50.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 109 113 109.612697 $5480.6300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.277778 $6.9500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 78 82 80.302382 $4015.1100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 155 163 141.594440 $7079.7000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 8 4.172221 $104.3000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 72 77 352.469839 $19033.3700 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 7 7 31.214285 $1685.5700 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 12 12 57.033335 $4637.9400 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 0.071429 $5.8100 $81.2900
OCCT -97530TL OT SESSION BY LICENSED OT 2 2 1.571429 $127.7900 $81.3200
OCCT -97530TLHM OT SESSION BY OT ASST 1 1 4.785714 $311.6400 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 8 8 16.957143 $1378.9500 $81.3200
PHY -97110GPGT PT SESSION BY LICENSED PT 1 1 1.142857 $92.9400 $81.3200
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 2.000000 $918.4400 $459.2200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 14 14 73.142859 $5947.9700 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 1.571429 $127.7900 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 2.500000 $203.3000 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 4.142857 $336.9000 $81.3200
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Subtotal (Total Children Is Unduplicated) 459 879 1250.848008 $159769.5900 $127.7300
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Total 954 1320.194041 $162410.9700 $123.0200
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Number of Children (Unduplicated) With at Least One Authorization 474