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 3891 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 2 2 0.738889 $35.8400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 6 7 5.877778 $329.7400 $56.1000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 2 0.777778 $35.2500 $45.3200
OCTH -97165 OT EVAL LOW COMPLEXITY 8 9 3.427778 $176.2200 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 2 2 1.222222 $62.8300 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.705556 $36.2700 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 9 10 29.741269 $1529.0000 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 9 12 6.533335 $335.8900 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 6 7 8.312700 $427.3600 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 3 3 1.277778 $65.6900 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 8 13 8.233334 $423.2800 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 14 16 29.798414 $1531.9500 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 11 16 54.993651 $2827.2300 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 16 18 11.696825 $601.3300 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 0.761111 $39.1300 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 3 4 15.450001 $794.2900 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 5 8 4.377778 $225.0600 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.077778 $4.0000 $51.4200
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 3.285714 $168.9200 $51.4100
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Subtotal (Total Children Is Unduplicated) 71 133 187.289689 $9649.2800 $51.5200
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 4 4 11.714286 $585.7200 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 1.038889 $240.6300 $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 9 13 21.572222 $1078.6100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 6 11.355554 $283.8900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 27 29 80.394442 $4019.7100 $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 12 14 17.020633 $851.0300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 0.366666 $9.1700 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 5 5 46.285714 $1157.1400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 19 20 107.999999 $2700.0000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 11 13 191.142857 $9557.1400 $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 183 255 3896.714282 $194835.6900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 168 223 3903.987303 $195199.3700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1699 2583 41791.365891 $501496.3700 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 10 12 114.000002 $8203.4300 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 3 3 48.571428 $2797.7100 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 10 13 155.785714 $11210.3400 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 12 19 322.714287 $23222.5100 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 10 14 165.214286 $11888.8100 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 14 19 222.214286 $15990.5300 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 15 20 324.785714 $23371.5800 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 2.000000 $27.9200 $13.9600
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Subtotal (Total Children Is Unduplicated) 1801 3532 51640.897643 $1018536.1300 $19.7200
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Total 3891 52174.069078 $1028185.4100 $19.7100
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Number of Children (Unduplicated) With at Least One Authorization 1911