Summary Report for FSPSAs Ending During the Report Period Center: 53
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: 07-01-21 and 06-30-22 Date of Report: 08-08-22 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 3517 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
CASE -CASE NON-TCM CASE MANAGEMENT 1 1 0.250000 $9.2500 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 45 48 92.211113 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 1.833333 $67.8300 $37.0000
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Subtotal (Total Children Is Unduplicated) 47 50 94.294446 $77.0800 $0.8200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 21 24 32.973016 $1599.2000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 4 5 5.000000 $278.5500 $55.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 2 2.011111 $47.2600 $23.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 11 11 5.211111 $75.9800 $14.5800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 142 149 178.347620 $4191.1700 $23.5000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 0.250000 $21.2100 $84.8400
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 6 5.361111 $241.2500 $45.0000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 1.000000 $55.5000 $55.5000
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 11.142857 $568.8500 $51.0500
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 2.000000 $102.1000 $51.0500
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 0.400000 $21.0300 $52.5700
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Subtotal (Total Children Is Unduplicated) 186 202 243.696826 $7202.0900 $29.5500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 15 21 22.288096 $111440.5000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 4 4 30.428571 $1521.4300 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.966667 $66.5700 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 33 35 33.405555 $7683.2700 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 24 31 27.000000 $1350.0000 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 31 37 67.557936 $3377.9000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 5 4.500000 $112.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 11 11 24.277778 $1213.8900 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 19 22 87.345238 $4367.2700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 3 2.844444 $71.1100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 64 71 170.461110 $8523.0500 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 104 121 278.781745 $13939.0800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 20 20 26.116668 $652.9200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 28 33 115.933335 $5796.6800 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 50 60 202.468255 $10123.4100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 2.900000 $72.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 45 48 107.234126 $5361.7100 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 64 70 149.188096 $7459.4200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 15 16 19.794445 $494.8600 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 3 3 24.142857 $1207.1400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 280 352 4311.480158 $215574.0000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 686 1002 11579.525378 $578976.2700 $50.0000
INTR -T1013 INTERPRETER 2 2 11.433333 $571.6700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 325 491 4220.496813 $42204.9700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 42 50 539.055557 $38510.1300 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 27 36 323.933331 $23141.7800 $71.4400
OCCT -97530TL OT SESSION BY LICENSED OT 36 49 410.842855 $29350.6200 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 103 134 1333.499205 $95265.2100 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 26 38 365.603173 $26118.6700 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 10 13 72.542857 $5182.4600 $71.4400
PHY -97110TL PT SESSION BY LICENSED PT 31 38 300.971425 $21501.3900 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 71 83 617.147618 $44089.0200 $71.4400
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.722222 $329.3200 $455.9900
SENS -V5264 EARMOLD 5 7 13.688889 $246.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 58 75 804.096823 $57444.7000 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 40 55 618.528572 $44187.7000 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 37 55 617.041270 $44081.4400 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 132 166 2099.245236 $149970.0800 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 2.166667 $30.0700 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 2 3 23.866666 $331.2700 $13.8800
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Subtotal (Total Children Is Unduplicated) 1215 3265 29663.522970 $1601942.3500 $54.0000
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Total 3517 30001.514242 $1609221.5200 $53.6400
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Number of Children (Unduplicated) With at Least One Authorization 1243