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: 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 1154 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
CASE -CASE NON-TCM CASE MANAGEMENT 1 1 0.008333 $0.3100 $37.0600
SCONLY-SCONLY *SERVICE COORDINATION ONLY 17 17 22.150001 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 1.600000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 19 19 23.758334 $0.3100 $0.0100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 5 5 5.000000 $242.5000 $48.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.300000 $7.1000 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.183333 $2.6900 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 47 47 20.033331 $442.1300 $22.0700
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.300000 $6.3100 $21.0400
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 3.571429 $189.0300 $52.9300
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Subtotal (Total Children Is Unduplicated) 54 56 29.388093 $889.7700 $30.2800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 3.577778 $17889.0000 $5000.0300
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 1.861112 $431.0900 $231.6300
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 12 19 22.642858 $1132.1400 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 5 5 3.142857 $157.1500 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 10 12 9.494444 $474.7200 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 0.133333 $6.6700 $49.9900
CONOF -CONOF CONSULT, OT, FACE TO FACE 54 56 53.264286 $2663.2200 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 3 3 5.600000 $280.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.066667 $26.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 21 22 31.688888 $1584.4400 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 1 1 2.000000 $100.0000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 28 30 38.939684 $1946.9900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 1 1 0.238889 $11.9500 $50.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 21 22 84.704759 $4235.2400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 232 243 1221.742854 $61087.1400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 11 11 53.161906 $2658.0900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 403 506 2160.838093 $21608.3900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 23 24 121.028571 $8709.2300 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 4.571429 $328.9600 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 11 13 77.790476 $5597.8000 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 0.266667 $19.1900 $71.9700
PHY -97110 PT SESSION BY LICENSED PT 25 25 138.204761 $9945.2300 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 13 13 73.885714 $5316.8200 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 3 3 41.000000 $2950.3700 $71.9600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.600000 $275.5300 $459.2200
SENS -V5264 EARMOLD 1 1 0.600000 $10.8800 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 40 42 229.971429 $16548.7400 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 13 13 51.357144 $3695.6600 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 2 2 3.222222 $231.8700 $71.9600
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Subtotal (Total Children Is Unduplicated) 424 1079 4436.596821 $169923.1500 $38.3000
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Total 1154 4489.743248 $170813.2300 $38.0500
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Number of Children (Unduplicated) With at Least One Authorization 442