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: 04-01-23 and 06-30-23 Date of Report: 07-25-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 1840 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 51 52 43.621429 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 51 52 43.621429 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 6 7 6.244444 $350.3100 $56.1000
OCTH -97167 OT EVAL HIGH COMPLEXITY 3 3 1.138889 $58.5500 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 40 46 11.428566 $587.5200 $51.4100
PSTF -97164TL PT RE-EVAL EST PLAN CARE 1 1 0.200000 $10.2800 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 1 1 0.211111 $10.8500 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 2 0.650000 $33.4200 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 40 44 21.942858 $1128.0900 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 35 37 8.534125 $438.7300 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 2 4 0.777777 $39.9800 $51.4000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.122222 $6.2800 $51.4000
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 2.444444 $125.6700 $51.4100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 4 0.261111 $13.4200 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 3 3 7.714286 $396.5900 $51.4100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 99 157 61.669833 $3199.6900 $51.8800
EI Services, Class # 03
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $231.6200 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 25 63 25.721425 $1286.0500 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 8 8 20.996827 $1049.8500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.033333 $25.8300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 10 10 5.134126 $256.7100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.033333 $25.8300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 0.355556 $17.7800 $50.0100
CONSF -CONSF CONSULT, SLP, FACE TO FACE 5 5 2.177777 $108.8900 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 110 141 559.285706 $13982.1400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 36 37 267.571427 $13378.5900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 511 545 3991.142823 $199557.3500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 532 564 4167.022986 $50004.3300 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 18.142858 $1305.5600 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 70 77 435.714284 $31354.0200 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 2 2 16.714286 $1202.7600 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 68 75 356.428570 $25648.6700 $71.9600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 1.000000 $114.8100 $114.8100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.000000 $459.2200 $459.2200
SENS -V5264 EARMOLD 2 2 2.000000 $36.2600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 2 12.285715 $884.0800 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 82 90 401.071428 $28861.1600 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 1.642857 $118.2200 $71.9600
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 691 1631 10288.475317 $369909.7100 $35.9500
-------------------------------------------------------------------------------------------------------------------------------------
Total 1840 10393.766579 $373109.4000 $35.9000
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 730