Summary Report for FSPSAs Ending During the Report Period Center: 03
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: 10-01-22 and 12-31-22 Date of Report: 01-23-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 1391 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 53 55 29.422221 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 53 55 29.422221 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 24 26 18.677777 $905.8700 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 2.000000 $57.8400 $28.9200
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 0.180822 $20.9500 $115.8600
OCTH -97165 OT EVAL LOW COMPLEXITY 28 29 15.211111 $782.0000 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 3 3 0.353196 $18.1600 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 38 41 20.525399 $1055.2200 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 24 29 12.100000 $622.0600 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.133333 $6.8500 $51.4000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 95 113 61.952221 $3184.9700 $51.4100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 185 246 131.133859 $6653.9300 $50.7400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 21 22 17.805556 $89028.0000 $5000.0100
CONIF -CONIF CONSULT, ITDS FACE TO FACE 27 27 23.899999 $1195.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 69 79 83.622218 $4181.0900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 56 59 59.888888 $2994.4400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 110 116 110.792068 $5539.6300 $50.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 2 2 15.247619 $762.3800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 475 525 1885.803184 $94290.1200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 32 34 174.928574 $12587.8600 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 72 87 337.480956 $24285.1100 $71.9600
SENS -V5050 IN EAR MONAURAL HEARING AID 3 3 0.331507 $76.1400 $229.6700
SENS -V5264 EARMOLD 2 2 0.180822 $3.2800 $18.1400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 106 134 433.895243 $31223.0800 $71.9600
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 689 1090 3143.876634 $266166.1200 $84.6600
-------------------------------------------------------------------------------------------------------------------------------------
Total 1391 3304.432714 $272820.0500 $82.5600
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 743