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: 04-01-23 and 06-30-23 Date of Report: 07-25-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 1350 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 66 67 47.733332 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 66 67 47.733332 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 11 12 10.516666 $510.0600 $48.5000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 0.049315 $5.7100 $115.7700
OCTH -97165 OT EVAL LOW COMPLEXITY 29 30 14.311110 $735.7300 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 18 19 9.616668 $494.4000 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 32 39 18.044442 $927.6500 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 4.428571 $227.6700 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 75 85 46.706186 $2401.1600 $51.4100
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Subtotal (Total Children Is Unduplicated) 149 188 103.672958 $5302.3800 $51.1500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 11 12 8.679833 $43399.5000 $5000.0400
CONIF -CONIF CONSULT, ITDS FACE TO FACE 15 15 18.194446 $909.7300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 87 107 98.255554 $4912.7700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 51 53 49.144443 $2457.2200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 104 110 106.700005 $5335.0300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 477 549 1953.277786 $97663.8200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 36 41 199.800000 $14377.6200 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 75 95 259.528569 $18675.6900 $71.9600
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 0.355251 $81.5600 $229.5800
SENS -V5264 EARMOLD 2 2 0.049315 $0.8900 $18.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 92 109 355.014286 $25546.8400 $71.9600
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Subtotal (Total Children Is Unduplicated) 690 1095 3048.999488 $213360.6500 $69.9800
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Total 1350 3200.405778 $218663.0300 $68.3200
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Number of Children (Unduplicated) With at Least One Authorization 758