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: 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 2215 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 54 54 54.826984 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 54 54 54.826984 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 1.000000 $48.5000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 2 2.600000 $160.4500 $61.7100
AUDE -V5090 DISPENSING FEE PER HEARING AID 12 13 14.000000 $1621.3400 $115.8100
EXIT -EXIT COS Exit 189 192 192.000000 $9600.0000 $50.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 8.857143 $530.7200 $59.9200
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Subtotal (Total Children Is Unduplicated) 202 209 218.457143 $11961.0000 $54.7500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 29 29 38.715875 $2684.9500 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.200000 $13.8700 $69.3500
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 130 135 105.620009 $5281.0000 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 83 86 95.207637 $4760.3700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 15 17 13.516667 $337.9200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 11 13 20.454763 $1022.7400 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 2 2 3.133333 $156.6700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 4 4 7.704763 $385.2400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 3 3 6.133333 $306.6700 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 2 3 2.816667 $140.8400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1 1 2.800000 $140.0000 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 2 2 3.133333 $156.6700 $50.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 4 4 77.714286 $1942.8600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 583 670 3868.580951 $208903.3400 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 44 48 278.742858 $15052.1200 $54.0000
INTR -T1013 INTERPRETER 75 118 414.938097 $20746.9100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 602 713 4086.422219 $49037.0500 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 3 3 9.033333 $734.5900 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 2 2 17.285714 $1125.6400 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 14 17 72.926983 $5930.4200 $81.3200
PHY -97110GPGT PT SESSION BY LICENSED PT 1 1 10.285714 $836.4300 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 2 2 8.495238 $690.8400 $81.3200
PHY -97110HM PT SESSION BY PT ASST 7 9 49.714285 $3237.4000 $65.1200
PHY -97110HMGT PT SESSION BY PT ASST 4 4 27.857143 $1814.0500 $65.1200
SENS -V5060 BEHIND EAR HEARING AID 12 13 14.000000 $3214.5400 $229.6100
SENS -V5264 EARMOLD 23 24 32.169842 $583.2400 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 22 22 109.964288 $8942.2900 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 5 5 19.714285 $1603.1700 $81.3200
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Subtotal (Total Children Is Unduplicated) 729 1952 9398.281616 $344781.8000 $36.6900
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Total 2215 9671.565743 $356742.8000 $36.8900
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Number of Children (Unduplicated) With at Least One Authorization 794