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: 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 5025 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 4 4 1.988889 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 4 4 1.988889 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 519 521 516.038357 $11074.1800 $21.4600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 515 517 512.038357 $8269.4200 $16.1500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 513 515 510.038357 $4039.5000 $7.9200
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 1.000000 $10.8800 $10.8800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 512 514 509.038357 $16192.5100 $31.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 513 515 510.038357 $11802.2900 $23.1400
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 4 5.000000 $226.6000 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 5 8.000000 $926.4800 $115.8100
NUTR -97802 NUTRITIONAL EVAL, INITIAL 14 15 21.744443 $1087.2200 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 23 25 24.611111 $1430.1500 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 19 20 21.285714 $1236.9100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 6 6 6.000000 $348.6600 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 6 6 5.785714 $336.2100 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 30 32 32.000000 $1859.5200 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 42 44 45.442857 $2640.6900 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 32 33 230.961902 $13421.1900 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 5 5 24.857143 $1444.4500 $58.1100
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Subtotal (Total Children Is Unduplicated) 631 2779 2984.880669 $76404.9600 $25.6000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 4.000000 $20000.0000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 149 179 234.656748 $11732.8400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 33 34 37.977776 $1898.8800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 19 20 11.500001 $575.0100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 94 98 119.766666 $5988.3300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 995 1078 6777.713854 $365996.6600 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 200 213 1141.732548 $92845.7300 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 258 273 1243.265894 $101102.4400 $81.3200
SENS -V5050 IN EAR MONAURAL HEARING AID 4 4 7.000000 $1607.2700 $229.6100
SENS -V5264 EARMOLD 4 4 7.000000 $126.9100 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 307 335 1850.977791 $150521.5300 $81.3200
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Subtotal (Total Children Is Unduplicated) 1334 2242 11435.591278 $752395.5800 $65.7900
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Total 5025 14422.460836 $828800.5400 $57.4700
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Number of Children (Unduplicated) With at Least One Authorization 1395