Summary Report for FSPSAs Initiated During the Report Period Center: 10
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 809 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 5 5 1.500000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 5 1.500000 $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 -92558 OTOACOUSTIC EMISSIONS (SCREENING) 1 1 1.000000 $6.8700 $6.8700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 18 18 18.000000 $142.5600 $7.9200
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 1.000000 $10.8800 $10.8800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 18 18 18.000000 $572.5800 $31.8100
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 1.000000 $15.1900 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 18 18 18.000000 $416.5200 $23.1400
NUTR -97802 NUTRITIONAL EVAL, INITIAL 8 8 13.123810 $656.1900 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 3 3 3.000000 $174.3300 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 4 4 5.600000 $325.4200 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 2.000000 $116.2200 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 11 11 10.300000 $598.5300 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 6 6 52.714285 $3063.2300 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 6.857143 $398.4700 $58.1100
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Subtotal (Total Children Is Unduplicated) 52 132 190.595238 $7327.7900 $38.4500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 116 147 231.806353 $11590.3400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 26 29 46.958729 $2347.9300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 11 11 22.063492 $1103.1800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 77 81 106.946032 $5347.3000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 239 282 2096.987293 $113237.3400 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 23 25 203.107144 $16516.6600 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 41 42 328.292859 $26696.7800 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 52 54 333.500003 $27120.2200 $81.3200
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Subtotal (Total Children Is Unduplicated) 398 672 3370.661905 $208959.7400 $61.9900
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Total 809 3562.757143 $216287.5300 $60.7100
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Number of Children (Unduplicated) With at Least One Authorization 412