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: 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 3841 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 53 59 101.197621 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 54 60 101.447621 $9.2500 $0.0900
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 20 25 32.095238 $1556.6200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $55.7100 $55.7100
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 12 12 10.500000 $246.7500 $23.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.016667 $14.8200 $14.5800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 206 222 225.446828 $5298.0100 $23.5000
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 6 5.822222 $262.0000 $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 4 4 19.304762 $1014.8500 $52.5700
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 244 274 309.328574 $9175.2100 $29.6600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 18 23 19.866666 $99333.0000 $4999.9800
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.966667 $66.5700 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 22 25 27.911112 $6419.5800 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 25 32 27.783333 $1389.1700 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 29 35 64.185714 $3209.2900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 5 4.500000 $112.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 7 7 18.211111 $910.5600 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 11 13 48.600793 $2430.0400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 2.000000 $50.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 69 83 171.419841 $8571.0000 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 77 88 243.853967 $12192.6900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 20 21 46.330159 $1158.2600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 45 60 166.097623 $8304.9000 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 35 44 153.354763 $7667.7400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.900000 $47.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 47 53 97.738095 $4886.9000 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 40 42 113.565079 $5678.2600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 8 8 13.422222 $335.5600 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 25 27 766.961901 $38348.0900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 454 529 5423.044412 $271152.2800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 593 796 10330.761870 $516538.1500 $50.0000
INTR -T1013 INTERPRETER 1 1 9.000000 $450.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 581 878 6422.653914 $64226.5700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 43 54 564.291268 $40312.9900 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 18 22 199.714285 $14267.5900 $71.4400
OCCT -97530TL OT SESSION BY LICENSED OT 43 56 500.047614 $35723.4200 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 70 90 1024.737300 $73207.2800 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 31 47 541.953965 $38717.1900 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 9 11 91.703174 $6551.2800 $71.4400
PHY -97110TL PT SESSION BY LICENSED PT 37 51 404.647614 $28908.0400 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 49 56 531.819047 $37993.1500 $71.4400
SENS -V5264 EARMOLD 3 6 11.111111 $200.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 78 104 915.034912 $65370.1400 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 29 40 484.771426 $34632.0900 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 52 62 645.171427 $46091.0800 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 104 131 1857.826185 $132723.1300 $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 1 2 23.133333 $321.0900 $13.8800
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1263 3507 31972.258570 $1608527.0900 $50.3100
-------------------------------------------------------------------------------------------------------------------------------------
Total 3841 32383.034765 $1617711.5400 $49.9600
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1296