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: 07-01-22 and 06-30-23 Date of Report: 07-25-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 5975 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 219 257 347.042851 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 219 257 347.042851 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 58 85 72.036607 $3493.7800 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 4 4.000000 $115.6800 $28.9200
AUDE -V5090 DISPENSING FEE PER HEARING AID 6 7 3.167124 $366.7800 $115.8100
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 1 1 1.000000 $55.5000 $55.5000
OCTH -97165 OT EVAL LOW COMPLEXITY 81 133 87.501446 $4498.4500 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 11 16 8.179527 $420.5000 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 89 136 99.334921 $5106.8100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 84 130 77.433339 $3980.8800 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 5 5 12.415873 $638.3000 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 231 409 280.557424 $14423.4500 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 2 1.205555 $61.9700 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 6.857143 $352.5200 $51.4100
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Subtotal (Total Children Is Unduplicated) 450 929 653.688959 $33514.6200 $51.2700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 56 78 69.697492 $348489.5000 $5000.0300
CONIF -CONIF CONSULT, ITDS FACE TO FACE 67 98 221.302378 $11065.1000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 270 417 876.599996 $43829.9800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 144 235 493.666668 $24683.3400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 341 553 1216.680153 $60833.9900 $50.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 4 4 30.666667 $1533.3400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1192 2355 17800.190481 $890009.6200 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 17.857143 $892.8600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 97 183 1630.630161 $117340.1800 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 181 355 2638.050799 $189834.1400 $71.9600
SENS -V5050 IN EAR MONAURAL HEARING AID 7 8 7.738357 $1776.7900 $229.6100
SENS -V5264 EARMOLD 6 7 2.838357 $51.4600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 252 495 3102.852375 $223281.2400 $71.9600
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Subtotal (Total Children Is Unduplicated) 1662 4789 28108.771027 $1913621.5300 $68.0800
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Total 5975 29109.502837 $1947136.1500 $66.8900
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Number of Children (Unduplicated) With at Least One Authorization 1825