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: 07-01-23 and 09-30-23 Date of Report: 10-10-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 794 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 14 14 17.472224 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 14 14 17.472224 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 6 6 5.344444 $259.2000 $48.5000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 3 3 2.377778 $37.6600 $15.8400
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 42 42 22.233336 $490.7000 $22.0700
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.450000 $20.3900 $45.3200
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 2.785714 $348.2100 $125.0000
EXIT -EXIT COS Exit 1 1 1.000000 $50.0000 $50.0000
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 2.600000 $133.6700 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 2 2 26.142857 $1344.0000 $51.4100
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Subtotal (Total Children Is Unduplicated) 55 57 62.934129 $2683.8400 $42.6500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 8 7.344444 $36722.0000 $4999.9700
AUDE -V5160 DISPENSING FEE BINAURAL 5 5 4.900000 $1134.9400 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 11 12 9.169047 $458.4500 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 6 6 5.000000 $250.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.000000 $25.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4 4 4.144445 $207.2300 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 1 1 1.377778 $68.8900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 43 46 66.063972 $3303.2100 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 3 3 2.377778 $118.8900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 23 25 38.050003 $1902.5200 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 1 1 0.933333 $46.6700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 32 32 44.703173 $2235.1500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 1.333334 $33.3400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 6 7 37.457143 $1872.8600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 206 215 1040.719059 $52035.9200 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 9 9 53.752381 $2687.6100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 152 176 887.710321 $10652.5200 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 43 47 216.320636 $15566.4200 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 2 8.285714 $596.2400 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 16 17 90.552382 $6516.1500 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 2 6.600000 $474.9400 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 18 18 100.549207 $7235.5200 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 8 8 62.895237 $4525.9400 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 1.733333 $124.7300 $71.9600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.900000 $413.3000 $459.2200
SENS -V5264 EARMOLD 1 1 0.900000 $16.3200 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 44 45 247.942858 $17841.9600 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 0.566667 $40.7800 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 25 26 127.712699 $9190.2000 $71.9600
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Subtotal (Total Children Is Unduplicated) 405 723 3070.994944 $176297.6500 $57.4100
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Total 794 3151.401297 $178981.4900 $56.7900
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Number of Children (Unduplicated) With at Least One Authorization 419