Summary Report for FSPSAs Initiated During the Report Period Center: 04
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 1744 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 41 41 21.942857 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 41 41 21.942857 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 2 2 3.775397 $183.1100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 6 6 4.411111 $247.4600 $56.1000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.172222 $7.8000 $45.3100
OCTH -97165 OT EVAL LOW COMPLEXITY 8 8 1.222222 $62.8300 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 22 23 5.205554 $267.6100 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 4 4 2.011111 $103.3900 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 11 11 4.172223 $214.5000 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 8 9 1.961111 $100.8200 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 0.783333 $40.2700 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 14 15 3.433331 $176.5000 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 9 9 2.461112 $126.5300 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 4 5 1.088889 $55.9800 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 7 7 5.465079 $280.9600 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 25 27 16.557937 $851.2500 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 0.483333 $24.8500 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 12 13 4.311110 $221.6300 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 4 5 0.900000 $46.2700 $51.4100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.455556 $20.4400 $44.8600
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Subtotal (Total Children Is Unduplicated) 96 149 58.870631 $3032.1900 $51.5100
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 34 90 22.861508 $1143.0800 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2 2 0.966666 $48.3300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 3 1.955555 $48.8900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 8 8 6.849999 $342.5000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 1.911111 $47.7800 $25.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.044444 $1.1100 $24.9800
CONSF -CONSF CONSULT, SLP, FACE TO FACE 6 6 7.400000 $370.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.011111 $0.2800 $24.9800
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 10 13 99.857143 $2496.4200 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 72 86 569.928578 $14248.2100 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 2.428571 $121.4300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 314 321 2901.857150 $145092.7800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 225 231 1270.057144 $63502.8000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 519 543 4107.010323 $41070.0800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 15 16 123.000000 $8851.0600 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 1 1 10.571429 $608.9100 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 69 74 414.257548 $29809.9300 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 4.428571 $318.6800 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 9 10 68.571429 $4934.4000 $71.9600
PHY -97110HM PT SESSION BY PT ASST 4 4 22.071429 $1270.4300 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 42 48 247.785721 $17830.6200 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 12.857143 $925.2000 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 14 14 99.285714 $7144.6100 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 64 71 398.000008 $28640.0300 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 2 2 11.000000 $791.5600 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 4 4 23.428572 $327.0600 $13.9600
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Subtotal (Total Children Is Unduplicated) 654 1554 10428.396867 $369986.1600 $35.4800
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Total 1744 10509.210355 $373018.3500 $35.4900
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Number of Children (Unduplicated) With at Least One Authorization 692