Summary Report for FSPSAs Initiated During the Report Period Center: 03
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: 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 1075 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 52 52 29.672220 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 52 52 29.672220 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 11 13 8.834855 $428.4900 $48.5000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 0.871233 $100.8900 $115.8100
OCTH -97165 OT EVAL LOW COMPLEXITY 12 13 4.366666 $224.4900 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 24 26 13.344445 $686.0400 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 22 28 11.472220 $589.7800 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 62 83 42.966745 $2208.9300 $51.4100
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Subtotal (Total Children Is Unduplicated) 118 166 81.856164 $4238.6100 $51.7800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 10 11 9.215677 $46078.0000 $4999.9600
CONIF -CONIF CONSULT, ITDS FACE TO FACE 9 9 13.311112 $665.5600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 62 67 83.299999 $4165.0000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 32 36 38.077776 $1903.8800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 88 98 130.805556 $6540.2800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 325 450 1962.833333 $98141.6700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 12 14 75.657143 $5444.2800 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 50 66 277.528572 $19970.9400 $71.9600
SENS -V5050 IN EAR MONAURAL HEARING AID 3 3 2.128311 $488.6800 $229.6100
SENS -V5264 EARMOLD 3 3 0.690411 $12.5200 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 64 100 334.411113 $24064.1800 $71.9600
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Subtotal (Total Children Is Unduplicated) 458 857 2927.959003 $207474.9800 $70.8600
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Total 1075 3039.487387 $211713.5900 $69.6500
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Number of Children (Unduplicated) With at Least One Authorization 503