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: 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 865 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 22 22 45.200000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 22 22 45.200000 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 14 16 14.316666 $694.3600 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 41 41 22.283336 $491.8000 $22.0700
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.4100 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 1.800000 $92.5400 $51.4100
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Subtotal (Total Children Is Unduplicated) 55 59 39.400002 $1330.1000 $33.7600
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 1 1 0.288889 $12.2500 $42.4100
ASST -ASST ASSISTIVE TECHNOLOGY 16 23 20.416667 $102083.5000 $5000.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 8 11 10.000000 $500.0000 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 2 2 1.250000 $62.5000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 0.400000 $10.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 8 8 17.494445 $874.7300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 37 40 47.629364 $2381.4700 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 1 1 1.000000 $50.0000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 31 32 42.996825 $2149.8400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 49 53 45.323016 $2266.1600 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 2 2 4.200000 $210.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 7.833333 $195.8300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 216 224 1055.842074 $52792.0500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 18 18 144.790476 $7239.5200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 93 128 410.700805 $4928.4100 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 35 38 171.628574 $12350.3700 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 39 41 194.866669 $14022.6000 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 3 3 9.400000 $676.4200 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 22 22 147.780954 $10634.3100 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 3 4 14.219048 $1023.2000 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 17 19 98.095240 $7058.9300 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 2 2 11.571429 $832.6800 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 43 44 228.528578 $16444.9200 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 3 4.166667 $299.8400 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 48 55 277.495242 $19968.5400 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 5 5 13.661904 $983.1100 $71.9600
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Subtotal (Total Children Is Unduplicated) 463 784 2981.580199 $260051.1500 $87.2200
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Total 865 3066.180201 $261381.2500 $85.2500
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Number of Children (Unduplicated) With at Least One Authorization 488