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: 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 1280 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 68 70 31.955554 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 68 70 31.955554 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 15 15 11.546196 $560.0000 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.000000 $28.9200 $28.9200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.221918 $25.7000 $115.8000
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 1 1 1.000000 $55.5000 $55.5000
OCTH -97165 OT EVAL LOW COMPLEXITY 28 33 15.888889 $816.8500 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 0.077778 $4.0000 $51.4200
PSTH -97161 PT EVAL LOW COMPLEXITY 21 22 9.299999 $478.1100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 23 24 8.766665 $450.6900 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 6.571429 $337.8400 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 71 84 34.714611 $1784.6700 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.183333 $8.2200 $44.8500
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Subtotal (Total Children Is Unduplicated) 142 184 89.270818 $4550.4900 $50.9700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 14 14 10.816667 $54083.5000 $5000.0200
CONIF -CONIF CONSULT, ITDS FACE TO FACE 10 11 12.444445 $622.2300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 88 100 98.877778 $4943.8900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 38 44 42.222224 $2111.1200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 111 123 129.360317 $6468.0100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 456 528 1898.755559 $94937.7700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 35 41 130.836507 $9414.9900 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 57 59 245.176193 $17642.8800 $71.9600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.073973 $16.9900 $229.6900
SENS -V5264 EARMOLD 1 1 0.073973 $1.3400 $18.1400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 85 104 290.265079 $20887.4600 $71.9600
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Subtotal (Total Children Is Unduplicated) 656 1026 2858.902715 $211130.1800 $73.8500
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Total 1280 2980.129087 $215680.6700 $72.3700
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Number of Children (Unduplicated) With at Least One Authorization 725