Summary Report for FSPSAs Ending During the Report Period Center: 06
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 2196 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 56 57 43.241267 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 56 57 43.241267 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.633333 $100.7900 $61.7100
AUDE -V5090 DISPENSING FEE PER HEARING AID 8 8 8.000000 $926.4800 $115.8100
EXIT -EXIT COS Exit 153 153 152.142857 $7607.1500 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $119.8400 $59.9200
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Subtotal (Total Children Is Unduplicated) 163 164 165.776190 $8904.2600 $53.7100
EI Services, Class # 03
AUD -92630 AUD REHAB PRELING HEARING LOSS 31 33 39.144445 $2714.6700 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.055556 $3.8600 $69.4100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 111 113 95.101912 $4755.1100 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 69 70 59.613125 $2980.6600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 29 30 29.559846 $739.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3 4 3.900000 $195.0000 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 6 7 5.466667 $273.3400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 2.671429 $66.7900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3 3 2.800000 $140.0000 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 5 6 7.866667 $393.3400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1 3 1.833334 $91.6700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1 1 2.366667 $118.3400 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 3 3 2.900000 $145.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.600000 $15.0000 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 21 22 609.714284 $15242.8700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 4.571429 $123.4300 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 552 629 3589.785681 $193848.5100 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 42 49 293.185715 $15832.0100 $54.0000
INTR -T1013 INTERPRETER 106 165 454.849999 $22742.5000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 587 690 3924.228534 $47090.7600 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 10 10 52.385714 $4260.0000 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 2.000000 $162.6400 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 2 2 21.857142 $1423.3400 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 3.642857 $237.2300 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 25 28 150.386903 $12229.4500 $81.3200
PHY -97110GPGT PT SESSION BY LICENSED PT 1 1 0.533333 $43.3700 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 3 3 3.819842 $310.6300 $81.3200
PHY -97110HM PT SESSION BY PT ASST 11 12 34.278572 $2232.2200 $65.1200
PHY -97110HMGT PT SESSION BY PT ASST 5 7 26.428571 $1721.0200 $65.1200
SENS -V5060 BEHIND EAR HEARING AID 8 8 8.000000 $1836.8800 $229.6100
SENS -V5264 EARMOLD 19 21 26.511113 $480.6500 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 32 34 181.247617 $14739.0500 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 11 14 74.142856 $6029.2900 $81.3200
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Subtotal (Total Children Is Unduplicated) 772 1975 9715.449810 $353217.6200 $36.3600
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Total 2196 9924.467267 $362121.8700 $36.4900
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Number of Children (Unduplicated) With at Least One Authorization 831