Summary Report for FSPSAs Ending During the Report Period Center: 53
This report shows the total number of units/fees for FSPSAs ending during the report period.
(i.e., end 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 ending 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 1230 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 17 18 21.866666 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 1.000000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 18 19 22.866666 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 4 4 3.205556 $155.4700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.205556 $11.5300 $56.1100
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.205556 $3.0200 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 42 42 23.027783 $508.2300 $22.0700
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 1.000000 $75.0000 $75.0000
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Subtotal (Total Children Is Unduplicated) 47 49 27.644451 $753.2600 $27.2500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 5 4.205556 $21028.0000 $5000.0500
AUDE -V5160 DISPENSING FEE BINAURAL 6 6 4.505556 $1043.5900 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 8 11 8.000000 $400.0000 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 7 9 8.500000 $425.0000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 6 7 5.800000 $290.0000 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 1 1 0.622222 $31.1100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 62 65 53.266667 $2663.3400 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 1 1 2.000000 $100.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 2.227778 $55.7000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 25 25 35.172221 $1758.6100 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 1 1 0.750000 $37.5000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 24 25 26.484921 $1324.2500 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 2 2 1.911111 $95.5600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 2.411111 $60.2800 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 4 4 19.533334 $976.6700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 248 270 1312.668261 $65633.3900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 22 24 104.504760 $5225.2300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 399 546 2221.180966 $26654.1600 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 31 36 170.990480 $12304.4700 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 2.285714 $164.4800 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 17 17 66.276191 $4769.2300 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 2 16.571428 $1192.4900 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 18 19 101.109527 $7275.8300 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 19 19 104.155558 $7495.0400 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 2 2 12.714286 $914.9200 $71.9600
SENS -V5264 EARMOLD 1 1 0.844444 $15.3100 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 38 42 186.133336 $13394.1600 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 3 15.701587 $1129.8800 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 12 12 66.400000 $4778.1500 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 3.500000 $251.8600 $71.9600
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Subtotal (Total Children Is Unduplicated) 423 1162 4560.427015 $181488.1700 $39.8000
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Total 1230 4610.938132 $182241.4200 $39.5200
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Number of Children (Unduplicated) With at Least One Authorization 442