Summary Report for FSPSAs Ending During the Report Period Center: 01
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: 04-01-25 and 06-30-25 Date of Report: 07-19-25 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 7867 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 77 80 53.105554 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 77 80 53.105554 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 35 37 28.762407 $1394.9900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 13 13 14.200000 $876.2800 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 17 17 40.101586 $609.1400 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 4 4 3.200000 $68.6700 $21.4600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 4 4 3.200000 $83.3300 $26.0400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 3 2.400000 $38.7600 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 2.400000 $58.2700 $24.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 7 7 5.933333 $46.9900 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 5 5 13.628571 $433.5300 $31.8100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 4 4 3.200000 $158.6900 $49.5900
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 4 4 3.200000 $48.6100 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 10 10 16.628571 $384.7900 $23.1400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 2 2 1.888889 $153.4500 $81.2400
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.266667 $30.8900 $115.8200
EXIT -EXIT COS Exit 137 149 126.083759 $6304.1800 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 12 21 41.000000 $3075.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 9 9 18.000000 $1457.6400 $80.9800
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 4.000000 $323.9200 $80.9800
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 1 1 2.000000 $161.9600 $80.9800
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 3 3 6.000000 $485.8800 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 31 33 64.000000 $3834.8800 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 5 5 10.000000 $599.2000 $59.9200
IPDEF -T1024TSTL F/U PSYCH AND DEV EVAL BY EI PROF 25 29 57.000000 $4615.8600 $80.9800
IPDEF -T1024TSTLGT F/U PHYC AND DEV EVAL BY EI PROF 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 80 95 188.000000 $15224.2400 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 27 30 56.500000 $4575.3700 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 21 22 44.000000 $3563.1200 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 10 11 20.500000 $1660.0900 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 55 55 109.500000 $8867.3100 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 25 26 46.000000 $3725.0800 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 423 465 916.796672 $54934.4600 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 149 157 301.000000 $18035.9200 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 378 454 895.296672 $72501.1300 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 112 138 273.000000 $22107.5400 $80.9800
OCTH -97165 OT EVAL LOW COMPLEXITY 5 5 5.000000 $290.5500 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 5 5 4.054795 $235.6200 $58.1100
PSTH -97161TLGT PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 11 11 11.000000 $639.2100 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 6 6 37.552382 $2182.1700 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 0.142857 $8.3000 $58.1300
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Subtotal (Total Children Is Unduplicated) 996 1852 3381.437161 $234189.4200 $69.2600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 25 27 20.358752 $101794.0000 $5000.0100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.211111 $14.6400 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 7 7 7.194521 $1666.3900 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 341 386 398.035554 $19901.7900 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 88 100 86.050688 $4302.5200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 42 42 36.704110 $917.6000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 243 257 434.132534 $21706.5900 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 29 29 47.119046 $2355.9500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 9 9 10.733333 $268.3300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 86 90 140.685715 $7034.2900 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 18 18 31.147618 $1557.3800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 5 5 6.166666 $154.1700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 102 109 180.183333 $9009.1700 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 9 9 10.199999 $510.0000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.500000 $37.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 131 137 207.446028 $10372.2800 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 17 17 33.566666 $1678.3300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 7 15.699999 $392.5000 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 3 3 19.000001 $950.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 901 963 5924.307881 $319912.7700 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 140 159 921.052368 $49736.8700 $54.0000
INTR -T1013 INTERPRETER 258 315 516.433333 $25821.6800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1117 1469 8103.032027 $97236.4300 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 36 40 182.019048 $14801.8300 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 2 2 8.066667 $655.9800 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 1 1 3.400000 $276.4900 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 3 3 29.142857 $2369.9000 $81.3200
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 0.428571 $34.8500 $81.3300
PHY -97110 PT SESSION BY LICENSED PT 70 74 405.777772 $32997.8900 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 6 6 56.933332 $4629.8200 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 1 1 2.933333 $238.5400 $81.3200
PHY -97110TLGT PT SESSION BY LICENSED PT 2 2 3.961904 $322.1800 $81.3200
SENS -V5060 BEHIND EAR HEARING AID 3 3 2.655708 $609.7800 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 2.000000 $918.4400 $459.2200
SENS -V5264 EARMOLD 4 4 2.754947 $49.9500 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 84 86 468.709523 $38115.4500 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 6 6 22.323809 $1815.3800 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 4 4 15.985714 $1040.9900 $65.1200
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 0.142857 $9.3100 $65.1400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 3 3 14.609524 $1188.0400 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 7.000000 $569.2400 $81.3200
SPL -92507TLGTHM SPL THERAPY SESSION BY SLP ASST 1 1 1.000000 $65.1200 $65.1200
SPL -92508HA GROUP SPL SESSION PER CHILD 3 3 25.857143 $407.5100 $15.7600
TRAV -TRAVS Travel by mile 1176 1532 8195.884412 $3647.1600 $0.4400
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Subtotal (Total Children Is Unduplicated) 1462 5935 26602.548404 $782095.0000 $29.4000
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Total 7867 30037.091119 $1016284.4200 $33.8300
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Number of Children (Unduplicated) With at Least One Authorization 2020