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: 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 2615 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 192 235 329.081744 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 192 235 329.081744 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 37 46 40.432541 $1960.9800 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.000000 $28.9200 $28.9200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.358904 $41.5600 $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 15 25 17.533336 $901.4000 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 0.083333 $4.2800 $51.3900
PSTH -97161 PT EVAL LOW COMPLEXITY 9 12 8.388889 $431.2700 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 13 21 14.999999 $771.1400 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.4100 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 39 63 50.302382 $2586.0500 $51.4100
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Subtotal (Total Children Is Unduplicated) 97 172 135.099384 $6832.5300 $50.5700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 15 17 14.872223 $74361.5000 $5000.0300
CONIF -CONIF CONSULT, ITDS FACE TO FACE 67 83 200.236509 $10011.8300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 280 435 940.933331 $47046.6600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 121 209 458.836507 $22941.8200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 290 481 1173.313500 $58665.7200 $50.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 3 3 20.000000 $1000.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 385 830 6873.746018 $343687.4300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 15 27 263.009522 $18926.1800 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 27 45 320.547619 $23066.6200 $71.9600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.717808 $164.8100 $229.6100
SENS -V5264 EARMOLD 1 1 1.076712 $19.5200 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 51 76 525.585714 $37821.1500 $71.9600
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Subtotal (Total Children Is Unduplicated) 882 2208 10792.875463 $637713.2400 $59.0900
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Total 2615 11257.056591 $644545.7700 $57.2600
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Number of Children (Unduplicated) With at Least One Authorization 1063