Summary Report for FSPSAs Ending During the Report Period Center: 04
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 8398 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 186 226 345.881746 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 186 226 345.881746 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 6 8 22.659524 $1098.9900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 16 18 16.127778 $904.7700 $56.1000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 2 0.777778 $35.2500 $45.3200
OCTH -97165 OT EVAL LOW COMPLEXITY 63 74 86.553176 $4449.7100 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 0.211111 $10.8500 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 27 31 21.511110 $1105.8800 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.705556 $36.2700 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 6 6 3.433333 $176.5100 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 74 103 157.254763 $8084.4800 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 0.722222 $37.1300 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 67 90 49.445238 $2541.9800 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 28 33 24.396034 $1254.2100 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 13 16 8.366665 $430.1200 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 2 1.033334 $53.1300 $51.4100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 3 3 2.205556 $113.3900 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 61 91 44.488888 $2287.1700 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 53 74 136.919046 $7039.0000 $51.4100
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 1.000000 $15.1100 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 43 57 76.554764 $3935.7000 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 71 101 86.665075 $4455.4400 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 3 4 2.494444 $128.2400 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 9 14 21.711111 $1116.1700 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 38 47 23.927782 $1230.1500 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 6 8 3.800001 $195.3600 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 27 38 15.538887 $798.8400 $51.4100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 1.427778 $73.4000 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 2 2 11.000000 $565.5100 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 2 2 52.000000 $2673.3200 $51.4100
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Subtotal (Total Children Is Unduplicated) 360 831 872.930954 $44846.0900 $51.3700
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 4 4 11.714286 $585.7200 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 2 2.000000 $138.7000 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 6 6 5.038889 $1167.1100 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 65 249 171.846842 $8592.4200 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 10 14 24.638889 $1231.9500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 6 11.355554 $283.8900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 28 30 86.561109 $4328.0500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 7 9 15.166664 $379.1600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1 1 0.422222 $21.1100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.788889 $44.7200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 13 15 18.949204 $947.4600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 0.366666 $9.1700 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 22 27 282.714286 $7067.8600 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 240 558 5647.500003 $141187.5100 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 13 16 226.857142 $11342.8600 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 15.428571 $771.4300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 995 1397 20857.111913 $1042855.5500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 868 1206 20943.457948 $1047172.8400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1701 2585 41846.365891 $502156.3700 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 114 152 1799.071426 $129461.1800 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 25.857143 $1860.6800 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 43 64 522.594046 $30101.4200 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 151 212 2914.046828 $209694.7700 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 20.142857 $1449.4800 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 78 112 1313.000004 $94483.4700 $71.9600
PHY -97110HM PT SESSION BY PT ASST 34 66 437.285712 $25170.1800 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 8.571429 $493.3700 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 105 157 2079.214290 $149620.2200 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 21.714286 $1562.5600 $71.9600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 2 2.000000 $459.2200 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 3 3 3.000000 $1377.6600 $459.2200
SENS -V5264 EARMOLD 5 6 5.038889 $91.3600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 112 160 1294.852773 $93177.6300 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 3.571429 $205.7100 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 146 236 2793.499998 $201020.2500 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 2 3 37.999999 $2734.4900 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 18 33 251.999999 $3517.9200 $13.9600
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Subtotal (Total Children Is Unduplicated) 2027 7341 103702.746076 $3716765.4100 $35.8400
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Total 8398 104921.558776 $3761611.4900 $35.8500
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Number of Children (Unduplicated) With at Least One Authorization 2124