Summary Report for FSPSAs Ending During the Report Period Center: 10
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 1074 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 3 3 1.333334 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 3 3 1.333334 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 19 19 19.000000 $407.7400 $21.4600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 19 19 19.000000 $306.8500 $16.1500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 19 19 19.000000 $150.4800 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 19 19 19.000000 $604.3900 $31.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 19 19 19.000000 $439.6600 $23.1400
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.000000 $45.3200 $45.3200
NUTR -97802 NUTRITIONAL EVAL, INITIAL 8 8 9.622223 $481.1200 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 5 5 18.857143 $1095.7900 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 11 11 11.000000 $639.2100 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 9.142857 $531.2900 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 0.285714 $16.6000 $58.1100
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Subtotal (Total Children Is Unduplicated) 49 127 146.907937 $4834.6700 $32.9100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 174 204 228.392061 $11419.5900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 41 46 53.717462 $2685.8900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 32 34 25.911108 $1295.5400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 115 125 133.688887 $6684.4400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 357 404 2263.787291 $122244.5400 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 30 33 193.527778 $15737.6800 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 43 45 225.016668 $18298.3700 $81.3200
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 1.000000 $114.8100 $114.8100
SENS -V5264 EARMOLD 2 2 2.000000 $36.2600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 46 49 258.100002 $20988.6900 $81.3200
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Subtotal (Total Children Is Unduplicated) 553 944 3386.141257 $204505.8000 $60.3900
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Total 1074 3534.382528 $209340.4700 $59.2300
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Number of Children (Unduplicated) With at Least One Authorization 568