Summary Report for FSPSAs Ending During the Report Period Center: 54
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 1444 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 12 12 13.644445 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 12 12 13.644445 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 4 4 3.522222 $411.5000 $116.8300
AACIS -92597TL AAC INTIAL EVAL BY LICENSED SLP 2 2 2.000000 $233.6600 $116.8300
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 38 44 37.005557 $1794.7800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 23 25 12.144443 $749.4200 $61.7100
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.383333 $6.1900 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 26 26 20.205554 $490.5900 $24.2800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.744444 $23.6800 $31.8100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 3 1.911111 $94.7700 $49.5900
AUDE -V5010 ASSESSMENT FOR HEARING AID 19 20 7.938890 $359.8000 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 3 0.811112 $93.9500 $115.8200
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 1.544444 $89.7500 $58.1100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 107 131 88.211110 $4348.0700 $49.2900
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 5 5 4.577778 $219.4600 $47.9400
AACFIT-92609TL AAC FITTING, ADJUST, TRAINING VISIT 1 1 0.333333 $15.9800 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 26 28 44.355556 $221778.0000 $5000.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 1.544444 $357.7100 $231.6100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 181 208 179.808733 $8990.4400 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 16 16 17.111111 $855.5600 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3 3 2.738889 $136.9500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2 2 2.088889 $104.4500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3 3 1.611111 $80.5600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 404 460 2071.066675 $111837.6100 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 42 44 225.931748 $12200.3000 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 88 92 192.726190 $15672.5000 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 8 8 29.909525 $2432.2500 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 2 2 1.155556 $93.9700 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 17 20 63.639682 $4144.2200 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 2 2 0.819047 $53.3300 $65.1200
OCCT -97530TL OT SESSION BY LICENSED OT 51 53 130.465078 $10609.4200 $81.3200
OCCT -97530TLGO OT SESSION BY LICENSED OT 15 15 44.827779 $3645.3900 $81.3200
OCCT -97530TLGOGT OT SESSION BY LICENSED OT 1 1 0.388889 $31.6300 $81.3200
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 2 0.165873 $13.4800 $81.2800
OCCT -97530TLHM OT SESSION BY OT ASST 12 14 41.496032 $2702.2300 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 61 61 139.498414 $11344.0100 $81.3200
PHY -97110GP PT SESSION BY LICENSED PT 5 5 16.817460 $1367.6000 $81.3200
PHY -97110GPGT PT SESSION BY LICENSED PT 2 2 7.604762 $618.4100 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 3 3 3.519047 $286.1700 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 36 38 80.464287 $6543.3400 $81.3200
PHY -97110TLGP PT SESSION BY LICENSED PT 1 1 5.857143 $476.3000 $81.3200
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 7.285714 $592.4700 $81.3200
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 3 2.755556 $1265.4300 $459.2300
SENS -V5261 BEHIND EAR DIGITAL BINAURAL HEARING 1 1 1.000000 $980.7400 $980.7400
SENS -V5264 EARMOLD 7 9 32.879367 $596.1000 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 125 138 329.298414 $26778.5500 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 5 5 16.769841 $1363.7100 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 45 50 54.077779 $4397.6000 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 2 2 5.285714 $429.8400 $81.3200
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 658 1301 3760.875416 $453085.0600 $120.4700
-------------------------------------------------------------------------------------------------------------------------------------
Total 1444 3862.730971 $457433.1300 $118.4200
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 672