Summary Report for FSPSAs Initiated During the Report Period Center: 02
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: 01-01-23 and 03-31-23 Date of Report: 04-20-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 3103 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 2 2 4.541270 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 2 4.541270 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 27 28 19.044650 $923.6600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 0.106849 $6.0000 $56.1300
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 1.041096 $15.2800 $14.6800
EXIT -EXIT EXIT ASSESSMENT 16 16 24.428571 $1221.4300 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 3 3 5.000000 $277.5000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 112 113 222.505479 $16687.9100 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 45 45 89.500000 $6712.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 56 58 113.285714 $8496.4300 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 23 23 45.500000 $3412.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 127 139 270.791193 $15028.9100 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 12 13 26.000000 $1443.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 33 33 66.000000 $4950.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 16 18 34.000000 $2550.0000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 30 32 9.635159 $495.3400 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 0.366667 $18.8500 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 17 17 10.695814 $549.8800 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 3 3 21.205089 $1090.1500 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 2 2 10.450098 $537.2400 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 6 6 2.893683 $148.7700 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 3 3 0.811111 $41.7000 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 18 21 9.226256 $474.3200 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 5 5 9.703968 $498.8800 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 6 6 0.813700 $41.8300 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 3 3 1.600000 $82.2600 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 37 40 26.994305 $1387.7800 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 2 2 0.550000 $28.2800 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 0.400000 $20.5600 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 3 3 1.432877 $73.6700 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 2 2 1.164384 $59.8600 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 22 23 14.798402 $760.7900 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 1.416438 $72.8100 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.283333 $12.7100 $44.8500
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 0.344444 $15.4500 $44.8500
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 2 2 28.142857 $1489.6000 $52.9300
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Subtotal (Total Children Is Unduplicated) 312 680 1085.132137 $70727.2600 $65.1800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 32 33 84.505893 $422528.5000 $4999.9900
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.966667 $223.9100 $231.6300
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 45 45 39.464387 $1973.2300 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 4 4 6.005556 $300.2800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 0.044444 $1.1100 $24.9800
CONIF -CONIF CONSULT, ITDS FACE TO FACE 193 212 348.769416 $17438.5100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 102 105 162.102485 $8105.1600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 3.766667 $94.1700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 15 16 23.128572 $1156.4300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 191 195 290.312276 $14515.6800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.266667 $31.6700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 14 14 104.114284 $5205.7200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 165 168 1112.347609 $55617.4300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 29 29 171.285713 $8564.3000 $50.0000
INTR -T1013 INTERPRETER 30 52 107.071429 $5353.5700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 262 553 2050.686423 $20506.8800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 75 78 573.771424 $41288.6300 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 19.142857 $1377.5200 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 43 46 359.571426 $25874.7700 $71.9600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.966667 $443.9300 $459.2400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 87 90 617.695230 $44449.3800 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 4 5 41.000000 $2950.3600 $71.9600
TRAV -TRAVS Travel by mile 321 769 121710.615209 $54161.2300 $0.4500
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Subtotal (Total Children Is Unduplicated) 359 2421 127828.601301 $732162.3300 $5.7300
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Total 3103 128918.274708 $802889.5900 $6.2300
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Number of Children (Unduplicated) With at Least One Authorization 404