Summary Report for FSPSAs Initiated During the Report Period Center: 54
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 466 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 4.877778 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 5 4.877778 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 1 1 1.000000 $116.8300 $116.8300
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 24 26 16.650000 $807.5200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 1.211111 $74.7400 $61.7100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 2.161111 $52.4700 $24.2800
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 0.622222 $30.8500 $49.5900
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 -1.011111 $-55.5100 $54.9000
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 0.488889 $38.2600 $78.2500
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 4 9.496031 $430.3600 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.677778 $78.5000 $115.8100
OCTF -97168GT OT RE-EVAL EST PLAN CARE 1 1 10.428571 $606.0100 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 4 4 5.580953 $324.3100 $58.1100
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Subtotal (Total Children Is Unduplicated) 40 45 47.305555 $2504.3400 $52.9400
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 2 2 2.000000 $95.8800 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 13 15 35.988889 $179944.5000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 195 220 185.492068 $9274.6200 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 15 15 17.000000 $850.0000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2 2 2.500000 $125.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2 2 -3.450000 $-172.5000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2 3 -4.666667 $-233.3400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 57 64 291.138092 $15721.4700 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 10 11 38.247620 $2065.3800 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 26 26 37.065083 $3014.1400 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 1 1 0.266667 $21.6900 $81.3300
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 3.714286 $302.0500 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 1 1 2.571429 $167.4500 $65.1200
OCCT -97530TL OT SESSION BY LICENSED OT 5 6 13.004761 $1057.5400 $81.3200
OCCT -97530TLGO OT SESSION BY LICENSED OT 2 2 -5.571429 $-453.0700 $81.3200
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 0.071429 $5.8100 $81.2900
PHY -97110 PT SESSION BY LICENSED PT 11 11 60.404761 $4912.1200 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 1 1 -26.000000 $-2114.3200 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 2 3 8.288889 $674.0500 $81.3200
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.677778 $311.2600 $459.2300
SENS -V5264 EARMOLD 3 3 11.963492 $216.9000 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 21 21 38.766668 $3152.5100 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 3 3 -15.566667 $-1265.8800 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 -26.000000 $-2114.3200 $81.3200
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Subtotal (Total Children Is Unduplicated) 297 416 667.907149 $215558.9400 $322.7400
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Total 466 720.090482 $218063.2800 $302.8300
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Number of Children (Unduplicated) With at Least One Authorization 312