Summary Report for FSPSAs Initiated During the Report Period Center: 01
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: 01-01-23 and 03-31-23 Date of Report: 04-20-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 5252 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 58 58 49.561908 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 5.142857 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 59 59 54.704765 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 43 46 45.686757 $2215.8000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 5 5 4.164384 $233.6200 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 3 3 8.285714 $131.2500 $15.8400
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 1.000000 $23.6700 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $14.6800 $14.6800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 1.000000 $7.2000 $7.2000
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 1.000000 $45.0800 $45.0800
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 3 3 4.466667 $93.9800 $21.0400
EXIT -EXIT EXIT ASSESSMENT 47 49 55.793934 $2789.7000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 3 6.000000 $450.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 12 12 24.000000 $1800.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 10 10 18.500000 $1387.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 14 14 28.000000 $2100.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 40 40 77.500000 $4301.2500 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 12 12 24.000000 $1332.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 29 36 71.000000 $5325.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 11 13 26.000000 $1950.0000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 3 3 4.000000 $205.6400 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.021918 $1.1300 $51.3700
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.4100 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 2 2 9.176190 $485.7000 $52.9300
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Subtotal (Total Children Is Unduplicated) 178 266 428.595564 $26118.0100 $60.9400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 13 15 14.277625 $71387.5000 $4999.9600
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 2.000000 $463.2400 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 427 488 515.621541 $25781.0700 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 21 26 1.584936 $79.2200 $49.9800
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 69 75 99.585128 $2489.6300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 239 252 453.529367 $22676.4800 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 21 22 52.800000 $2640.0000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 10 12 12.155556 $303.8900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 102 106 214.155555 $10707.7800 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 10 10 19.435712 $971.7800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 7.288889 $182.2200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 101 104 190.925398 $9546.2800 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 7 7 10.166666 $508.3300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 5 5 4.955556 $123.8900 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 162 166 302.833332 $15141.6600 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 15 16 31.694443 $1584.7200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 10 10 31.500001 $787.5000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 44 47 280.019050 $14000.9500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 103 109 659.480950 $32974.0800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 5 5 53.428571 $2671.4300 $50.0000
INTR -T1013 INTERPRETER 187 241 456.744442 $22837.2300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1197 1566 9667.956294 $96679.6000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 15 15 94.966665 $6833.8200 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 7.000000 $503.7200 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 15 17 92.204762 $6635.0600 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 13 13 66.566666 $4790.1400 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 3 11.000000 $791.5600 $71.9600
TRAV -TRAVS Travel by mile 1205 1590 9715.056296 $4323.2000 $0.4400
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Subtotal (Total Children Is Unduplicated) 1343 4927 23068.933401 $358415.9500 $15.5400
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Total 5252 23552.233730 $384533.9600 $16.3300
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Number of Children (Unduplicated) With at Least One Authorization 1426