Summary Report for FSPSAs Ending During the Report Period Center: 03
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: 10-01-21 and 12-31-21 Date of Report: 02-04-22 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 877 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 54 55 25.516670 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 54 55 25.516670 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 23 28 18.383332 $891.5900 $48.5000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 0.117808 $13.5500 $114.9900
OCTH -97167 OT EVAL HIGH COMPLEXITY 2 2 0.348401 $17.7900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 12 15 7.366666 $376.0600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 16 19 5.405555 $275.9500 $51.0500
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Subtotal (Total Children Is Unduplicated) 49 66 31.621762 $1574.9300 $49.8100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 7 5.068874 $25344.5000 $5000.0300
CONIF -CONIF CONSULT, ITDS FACE TO FACE 33 38 56.522224 $2826.1200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 131 141 145.579363 $7278.9600 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 2 2 1.422222 $71.1100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 77 85 81.296823 $4064.8300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 184 214 201.507935 $10075.3900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 1 1 0.355556 $17.7800 $50.0100
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 201 227 808.182545 $40409.1200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 3 3 6.300000 $450.0700 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 12 15 61.971431 $4427.2400 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.076712 $17.4900 $227.9600
SENS -V5264 EARMOLD 1 1 0.076712 $1.3800 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 18 21 70.504762 $5036.8600 $71.4400
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Subtotal (Total Children Is Unduplicated) 477 756 1438.865159 $100020.8300 $69.5100
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Total 877 1496.003591 $101595.7700 $67.9100
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Number of Children (Unduplicated) With at Least One Authorization 532