Summary Report for FSPSAs Ending During the Report Period Center: 03
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 1102 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 69 71 37.466667 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 69 71 37.466667 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 10 11 10.461111 $507.3600 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 8 8 4.918645 $156.4600 $31.8100
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 0.380822 $44.1100 $115.8300
OCTH -97167 OT EVAL HIGH COMPLEXITY 34 37 20.727778 $1204.4900 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 4 4 1.911111 $111.0500 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 46 48 26.205558 $1522.8200 $58.1100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.355556 $20.6600 $58.1200
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 0.077778 $4.5200 $58.1300
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 71 74 42.774601 $2485.6200 $58.1100
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Subtotal (Total Children Is Unduplicated) 150 186 107.812960 $6057.1100 $56.1800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 12 13 10.527474 $52637.5000 $5000.0100
CONIF -CONIF CONSULT, ITDS FACE TO FACE 10 10 9.877777 $493.8900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 59 64 67.233337 $3361.6900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 30 32 33.942859 $1697.1600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 61 68 75.211115 $3760.5800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 394 460 1669.142839 $90133.7800 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 2 12.571428 $678.8600 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 41 48 154.109524 $12532.2100 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 55 60 236.936503 $19267.6900 $81.3200
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 0.380822 $87.4600 $229.6600
SENS -V5264 EARMOLD 2 2 0.380822 $6.9100 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 76 84 292.723808 $23804.3200 $81.3200
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Subtotal (Total Children Is Unduplicated) 567 845 2563.038308 $208462.0300 $81.3300
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Total 1102 2708.317935 $214519.1300 $79.2100
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Number of Children (Unduplicated) With at Least One Authorization 640