Summary Report for FSPSAs Initiated During the Report Period Center: 03
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 1115 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 76 77 41.388893 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 76 77 41.388893 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 14 16 12.644444 $613.2500 $48.5000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 0.194444 $2.9500 $15.1900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 6 6 4.196195 $133.4800 $31.8100
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.050000 $2.9100 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 38 44 29.111113 $1691.6600 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 37 37 20.438890 $1187.7100 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 50 60 39.180948 $2276.7800 $58.1100
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Subtotal (Total Children Is Unduplicated) 124 165 105.816034 $5908.7400 $55.8400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 15 17 15.602436 $78012.5000 $5000.0200
CONIF -CONIF CONSULT, ITDS FACE TO FACE 7 8 7.933333 $396.6700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 60 71 96.849210 $4842.4800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 26 33 38.544446 $1927.2300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 54 67 90.611116 $4530.5800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 358 495 2293.204784 $123832.9900 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 47 65 301.042862 $24480.8200 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 35 43 209.790479 $17060.1500 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 55 74 310.161910 $25222.3700 $81.3200
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Subtotal (Total Children Is Unduplicated) 494 873 3363.740576 $280305.7900 $83.3300
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Total 1115 3510.945503 $286214.5300 $81.5200
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Number of Children (Unduplicated) With at Least One Authorization 574