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: 07-01-22 and 09-30-22 Date of Report: 10-19-22 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 472 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 13 13 12.599207 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 13 13 12.599207 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 3 4 1.811112 $87.8400 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.150000 $2.9300 $19.5100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.000000 $22.0700 $22.0700
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Subtotal (Total Children Is Unduplicated) 5 6 2.961112 $112.8400 $38.1100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 1.972222 $9861.0000 $4999.9400
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.066667 $15.4500 $231.7400
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 2 2 0.571428 $28.5700 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 3 3 2.285714 $114.2900 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2 2 1.233333 $61.6700 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 1.450000 $72.5000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 35 37 57.088890 $2854.4500 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 20 20 17.466668 $873.3400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 9.898413 $247.4600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 18 18 24.793651 $1239.6800 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 6 6 22.030952 $1101.5500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 13 14 25.007935 $1250.3900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 11 11 10.850001 $542.5100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.000000 $25.0000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 9 9 281.619048 $14080.9500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 8 8 33.623810 $1681.1900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 3 3 15.019048 $750.9500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 230 299 1471.312700 $14713.1300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 0.322222 $23.1900 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 5.000000 $359.8000 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 1 1 5.714286 $411.2000 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 0.500000 $35.9800 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 5 5 45.133333 $3247.8000 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 1.571429 $113.0800 $71.9600
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Subtotal (Total Children Is Unduplicated) 265 453 2035.531750 $53705.1000 $26.3800
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Total 472 2051.092069 $53817.9400 $26.2400
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Number of Children (Unduplicated) With at Least One Authorization 277