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: 10-01-25 and 12-31-25 Date of Report: 01-07-26 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 1063 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 74 75 54.736515 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 74 75 54.736515 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 16 18 11.216667 $544.0100 $48.5000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 0.322222 $4.8900 $15.1900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 6 6 4.589193 $145.9800 $31.8100
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 0.455556 $26.4700 $58.1200
OCTH -97167 OT EVAL HIGH COMPLEXITY 59 65 35.699997 $2074.5100 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 36 39 18.855554 $1095.6900 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 64 69 36.956352 $2147.5500 $58.1100
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Subtotal (Total Children Is Unduplicated) 156 200 108.095541 $6039.1100 $55.8700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 17 17 13.558296 $67791.5000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 9 9 8.677777 $433.8900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 71 76 85.982538 $4299.1200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 35 43 52.577778 $2628.8900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 50 53 64.311110 $3215.5500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 376 407 2046.665072 $110519.9600 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 64 73 308.801590 $25111.7500 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 36 40 172.371427 $14017.2400 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 67 70 298.647615 $24286.0400 $81.3200
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Subtotal (Total Children Is Unduplicated) 537 788 3051.593203 $252303.9300 $82.6800
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Total 1063 3214.425259 $258343.0500 $80.3700
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Number of Children (Unduplicated) With at Least One Authorization 613