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 4976 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 66.332541 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 77 80 66.332541 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 20 20 17.050837 $826.9600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 2.000000 $123.4200 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 2 2 2.000000 $30.3800 $15.1900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 2.000000 $48.5600 $24.2800
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 118 130 111.583759 $5579.1800 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 5 10.000000 $750.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $161.9600 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $239.6800 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 9 9 17.000000 $1376.6600 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 6 6 11.000000 $890.7800 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 3 3 6.000000 $485.8800 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 1 1 1.500000 $121.4700 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 4 4 8.000000 $647.8400 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 5 5 7.500000 $607.3500 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 28 31 61.000000 $3655.1200 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 11 11 19.000000 $1138.4800 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 22 30 60.000000 $4858.8000 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 6 9 18.000000 $1457.6400 $80.9800
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 4 4 4.000000 $232.4400 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 11.857143 $689.0200 $58.1100
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Subtotal (Total Children Is Unduplicated) 205 285 381.980628 $24300.7400 $63.6200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 9 12 11.109588 $55548.0000 $5000.0100
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $231.6200 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 330 369 375.383173 $18769.1600 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 89 99 85.217355 $4260.8500 $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 91 95 176.027781 $8801.4100 $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 60 66 422.171436 $22797.2400 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 17 17 126.142859 $6811.7200 $54.0000
INTR -T1013 INTERPRETER 245 303 497.769049 $24888.4400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1156 1467 8838.326667 $106059.8700 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 3 3 21.285715 $1730.9500 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 6.142857 $499.5400 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 15 15 75.752383 $6160.2000 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 1 1 2.714286 $220.7300 $81.3200
SENS -V5060 BEHIND EAR HEARING AID 1 1 0.177778 $40.8200 $229.6400
SENS -V5264 EARMOLD 1 1 0.177778 $3.2200 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 15 16 101.890478 $8285.7300 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 15.142857 $1231.4100 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 10.714286 $697.7200 $65.1200
TRAV -TRAVS Travel by mile 1185 1538 8935.393334 $3976.2600 $0.4500
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Subtotal (Total Children Is Unduplicated) 1359 4611 20781.024446 $323057.3800 $15.5500
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Total 4976 21229.337615 $347358.1200 $16.3600
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Number of Children (Unduplicated) With at Least One Authorization 1513