Summary Report for FSPSAs Initiated During the Report Period Center: 01
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: 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 7792 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 91 94 74.632540 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 91 94 74.632540 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 22 22 20.050837 $972.4600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 11 11 12.900000 $796.0600 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 14 15 19.975397 $303.4300 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 3.133333 $67.2400 $21.4600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 3 3 4.133333 $107.6300 $26.0400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $16.1500 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 7 7 9.990476 $242.5700 $24.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 4 4 5.133333 $40.6600 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 3.133333 $99.6700 $31.8100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 2.133333 $105.7900 $49.5900
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 3.133333 $47.5900 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 12 12 16.133333 $373.3200 $23.1400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 2.733333 $150.0600 $54.9000
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 2 2 0.577778 $46.9400 $81.2400
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.000000 $45.3200 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.177778 $20.5900 $115.8200
EXIT -EXIT COS Exit 138 150 127.083759 $6354.1800 $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 9 10 18.500000 $1498.1300 $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 422 464 914.796672 $54814.6200 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 148 156 299.000000 $17916.0800 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 379 456 899.296672 $72825.0500 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 111 137 271.000000 $21945.5800 $80.9800
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 2.000000 $116.2200 $58.1100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 11 11 12.571429 $730.5200 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $58.1100 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 2.106849 $122.4300 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 4 4 15.614286 $907.3500 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 5.428571 $315.4600 $58.1100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 955 1816 3323.737168 $231826.8400 $69.7500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 18 21 19.898325 $99492.0000 $5000.0200
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 9.000000 $624.1500 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.294444 $20.4200 $69.3400
AUDE -V5160 DISPENSING FEE BINAURAL 4 4 5.000000 $1158.1000 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 333 373 389.668887 $19483.4500 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 89 100 86.717355 $4335.8500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 44 45 41.304110 $1032.6000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 230 251 432.242069 $21612.1300 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 35 41 64.496033 $3224.8100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 11 11 14.899999 $372.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 65 68 111.649999 $5582.5000 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 11 11 19.066666 $953.3300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 5 6.633333 $165.8300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 92 96 177.827781 $8891.4100 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 16 16 95.674461 $4783.7300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 4 4 7.733333 $193.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 122 129 239.303178 $11965.1700 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 14 14 24.495891 $1224.8000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 4.699999 $117.5000 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 3 4 16.285715 $814.2900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 935 992 6587.914373 $355747.2200 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 146 160 999.423824 $53968.8600 $54.0000
INTR -T1013 INTERPRETER 259 319 516.019049 $25800.9400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1157 1468 8849.183810 $106190.1600 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 32 33 199.923811 $16257.7700 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 3 3 6.133334 $498.7700 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 1 1 1.166667 $94.8800 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 6.142857 $499.5400 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 65 66 429.533343 $34929.6400 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 5 5 30.857144 $2509.3000 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 2 2 20.428572 $1661.2500 $81.3200
SENS -V5060 BEHIND EAR HEARING AID 2 2 2.177778 $500.0400 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 2.000000 $918.4400 $459.2200
SENS -V5264 EARMOLD 4 4 2.218722 $40.2300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 70 74 470.495247 $38260.6500 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 4 4 33.000000 $2683.5500 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 11.714286 $762.8400 $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 28.714286 $2335.0500 $81.3200
SPL -92508HA GROUP SPL SESSION PER CHILD 2 2 13.571429 $213.8900 $15.7600
TRAV -TRAVS Travel by mile 1185 1539 8946.107620 $3981.0300 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1376 5882 28923.760587 $833911.2100 $28.8300
-------------------------------------------------------------------------------------------------------------------------------------
Total 7792 32322.130295 $1065738.0400 $32.9700
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1708