Summary Report for FSPSAs Initiated During the Report Period Center: 03
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: 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 1380 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 38 38 21.300000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 38 38 21.300000 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 7 7 7.832540 $379.8800 $48.5000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 0.476712 $7.5500 $15.8400
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.655556 $18.9600 $28.9200
OCTH -97165 OT EVAL LOW COMPLEXITY 31 37 23.255555 $1195.5700 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 26 28 12.244446 $629.4900 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 46 53 34.844442 $1791.3400 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 3 3 2.333333 $119.9600 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 83 92 55.330160 $2844.5300 $51.4100
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Subtotal (Total Children Is Unduplicated) 176 222 136.972744 $6987.2700 $51.0100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 6 4.538889 $22694.5000 $5000.0100
CONIF -CONIF CONSULT, ITDS FACE TO FACE 22 23 24.977778 $1248.8900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 102 126 149.033332 $7451.6600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 42 49 60.003171 $3000.1400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 99 110 141.055556 $7052.7800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 372 530 2079.271417 $103963.6400 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 34 44 190.246029 $13690.1200 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 75 113 371.609524 $26741.0400 $71.9600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.476712 $109.4600 $229.6000
SENS -V5264 EARMOLD 1 1 0.476712 $8.6400 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 90 117 483.069047 $34761.7000 $71.9600
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Subtotal (Total Children Is Unduplicated) 579 1120 3504.758167 $220722.5600 $62.9800
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Total 1380 3663.030911 $227709.8300 $62.1600
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Number of Children (Unduplicated) With at Least One Authorization 621