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: 07-01-22 and 09-30-22 Date of Report: 10-19-22 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 991 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 11 11 13.211111 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 11 11 13.211111 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 5 5 3.372222 $163.5500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 11.571429 $649.1600 $56.1000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 11 11 10.400000 $202.9000 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.161111 $3.8100 $23.6700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 36 37 19.566665 $431.8300 $22.0700
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.161111 $3.3900 $21.0400
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Subtotal (Total Children Is Unduplicated) 52 56 45.232538 $1454.6500 $32.1600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 7 4.588889 $22944.5000 $5000.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 5 5 2.193650 $109.6800 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 2 2 1.285714 $64.2900 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 6 6 8.302380 $415.1200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 48 48 51.490477 $2574.5300 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 2 2 1.733333 $86.6700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 25 25 27.983334 $1399.1700 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 1 1 1.000000 $50.0000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 19 19 17.744442 $887.2100 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 2 2 2.000000 $100.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 4.966667 $124.1700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 14 15 76.630159 $3831.5200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 199 206 1070.480955 $53524.0400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 39 40 243.123808 $12156.2000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 340 422 1898.410320 $18984.1100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 25 26 156.423808 $11256.2600 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 10 10 51.171430 $3682.2900 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 2 11.695238 $841.5900 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 18 19 84.914286 $6110.4300 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 6 7 35.085714 $2524.7700 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 3 3 30.428571 $2189.6400 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 32 34 182.090476 $13103.2400 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 2 6.285714 $452.3300 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 11 11 34.766667 $2501.8100 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 5 5 37.304762 $2684.4600 $71.9600
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Subtotal (Total Children Is Unduplicated) 381 924 4042.100794 $162598.0000 $40.2300
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Total 991 4100.544443 $164052.6400 $40.0100
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Number of Children (Unduplicated) With at Least One Authorization 392