Summary Report for FSPSAs Initiated During the Report Period Center: 53
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: 10-01-21 and 12-31-21 Date of Report: 02-04-22 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 808 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 9 10 16.715874 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 9 10 16.715874 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 3 3 2.494444 $120.9800 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 35 35 21.527777 $505.9000 $23.5000
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 2.000000 $90.0000 $45.0000
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Subtotal (Total Children Is Unduplicated) 40 40 26.022221 $716.8800 $27.5500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.494444 $2472.0000 $4999.5600
AUDE -V5160 DISPENSING FEE BINAURAL 11 11 8.722222 $2006.1100 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 3 5 5.000000 $250.0000 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 9 9 16.697619 $834.8800 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2 2 2.361111 $118.0600 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 5 5 21.972221 $1098.6100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 13 14 15.861111 $793.0600 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 23 24 37.726986 $1886.3600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 6 6 4.372222 $109.3100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 14 16 33.069047 $1653.4500 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 18 19 45.742858 $2287.1400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.450000 $36.2500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 9 9 7.438888 $371.9400 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 9 9 25.053174 $1252.6600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 2.005555 $50.1400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 79 85 582.325395 $29116.2800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 217 229 1226.027770 $61301.3900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 107 127 532.762694 $5327.6300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 8 8 43.780952 $3127.7100 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 7 7 20.533333 $1466.9000 $71.4400
OCCT -97530TL OT SESSION BY LICENSED OT 12 12 42.552380 $3039.9400 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 26 26 270.922224 $19354.7000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 11 11 82.104761 $5865.5800 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 5 5 9.071430 $648.0700 $71.4400
PHY -97110TL PT SESSION BY LICENSED PT 10 10 24.680951 $1763.2000 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 22 23 101.299997 $7236.8700 $71.4400
SENS -V5264 EARMOLD 2 2 3.000000 $54.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 19 20 110.904759 $7923.0500 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 10 10 41.338094 $2953.1900 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 16 16 76.966665 $5498.5000 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 29 31 161.599999 $11544.7000 $71.4400
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 1.200000 $16.6600 $13.8800
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Subtotal (Total Children Is Unduplicated) 437 758 3559.038862 $181458.2800 $50.9900
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Total 808 3601.776957 $182175.1500 $50.5800
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Number of Children (Unduplicated) With at Least One Authorization 446