Summary Report for FSPSAs Ending During the Report Period Center: 03
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: 10-01-23 and 12-31-23 Date of Report: 01-14-24 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 1363 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 46 49 27.294446 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 46 49 27.294446 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 13 15 18.693652 $906.6400 $48.5000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 0.005479 $0.0900 $15.9000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.166667 $4.8200 $28.9300
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.022222 $2.5700 $115.7000
OCTH -97165 OT EVAL LOW COMPLEXITY 21 22 10.122224 $520.3900 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 23 23 13.477777 $692.8900 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 52 55 30.544448 $1570.3100 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 1.277778 $65.6900 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 99 108 67.469048 $3468.5900 $51.4100
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Subtotal (Total Children Is Unduplicated) 190 228 141.779295 $7231.9900 $51.0100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 14 15 8.916667 $44583.5000 $5000.0200
CONIF -CONIF CONSULT, ITDS FACE TO FACE 25 26 32.227778 $1611.3900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 110 128 142.711104 $7135.5200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 42 48 43.122220 $2156.1000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 97 108 110.199999 $5510.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 438 486 1869.919057 $93495.9700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 1.000000 $50.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 35 43 163.066666 $11734.2900 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 90 101 390.131749 $28073.9000 $71.9600
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 0.138812 $31.8700 $229.5900
SENS -V5264 EARMOLD 2 2 0.072146 $1.3100 $18.1400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 118 126 529.761904 $38121.7000 $71.9600
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Subtotal (Total Children Is Unduplicated) 687 1086 3291.268102 $232505.5400 $70.6400
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Total 1363 3460.341843 $239737.5300 $69.2800
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Number of Children (Unduplicated) With at Least One Authorization 740