Summary Report for FSPSAs Initiated During the Report Period Center: 06
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: 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 2076 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 49 49 41.526982 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 49 49 41.526982 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 1 2 3.333333 $205.7000 $61.7100
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 5 5.000000 $579.0500 $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
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 193 200 209.190476 $10915.4700 $52.1800
EI Services, Class # 03
AUD -92630 AUD REHAB PRELING HEARING LOSS 31 31 47.430161 $3289.3100 $69.3500
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 134 137 113.307850 $5665.3900 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 78 80 81.258233 $4062.9000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 15 17 12.516667 $312.9200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 11 12 15.733334 $786.6700 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 7 8 11.150001 $557.5100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 2.450000 $61.2500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 5 5 3.749999 $187.5000 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 5 5 11.400000 $570.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 4.300000 $107.5000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 4 4 6.133334 $306.6700 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 4 4 4.400001 $220.0100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1 1 2.000000 $100.0000 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 3 3 3.766667 $188.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.500000 $37.5000 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 31.428571 $785.7200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 517 622 3802.612634 $205341.1500 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 47 54 320.142852 $17287.7200 $54.0000
INTR -T1013 INTERPRETER 70 113 330.035714 $16501.7900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 527 650 3974.945965 $47699.3700 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 4 27.109524 $2204.5500 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 1 1 4.142857 $269.7900 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 9 9 49.428571 $4019.5300 $81.3200
PHY -97110HM PT SESSION BY PT ASST 4 4 36.257142 $2361.0700 $65.1200
PHY -97110HMGT PT SESSION BY PT ASST 2 2 14.714285 $958.2000 $65.1200
SENS -V5060 BEHIND EAR HEARING AID 7 8 8.000000 $1836.8800 $229.6100
SENS -V5264 EARMOLD 22 23 38.471430 $697.4900 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 12 14 92.607142 $7530.8000 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 8 10 61.909522 $5034.5100 $81.3200
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 638 1827 9112.902456 $328981.9900 $36.1000
-------------------------------------------------------------------------------------------------------------------------------------
Total 2076 9363.619914 $339897.4600 $36.3000
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 840