Summary Report for FSPSAs Initiated During the Report Period Center: 04
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 8293 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 195 220 336.437297 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 195 220 336.437297 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 5 5 6.269842 $304.0900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 22 26 23.249999 $1304.3200 $56.1000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.172222 $7.8000 $45.3100
OCTH -97165 OT EVAL LOW COMPLEXITY 42 45 28.916667 $1486.6100 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 28 33 24.605555 $1264.9700 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 5 5 3.416666 $175.6500 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 41 51 82.942066 $4264.0600 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 107 151 80.523011 $4139.6700 $51.4100
PSTF -97164TL PT RE-EVAL EST PLAN CARE 1 1 0.200000 $10.2800 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 19 20 18.973810 $975.4400 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 12 15 7.716665 $396.7100 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.805556 $41.4200 $51.4100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 2 2 1.822223 $93.6800 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 33 41 27.311113 $1404.0700 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 95 136 133.267458 $6851.2700 $51.4100
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 2 2.000000 $30.2200 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 28 35 26.589683 $1366.9800 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 105 157 113.509522 $5835.5200 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 3 4 2.494444 $128.2400 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 9 16 10.200000 $524.3800 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 23 27 15.305558 $786.8700 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 8 11 6.044445 $310.7500 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 15 15 9.566666 $491.8200 $51.4100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 6 1.577778 $81.1100 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 2 19.428571 $998.8200 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 4 5 59.714286 $3069.9100 $51.4100
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Subtotal (Total Children Is Unduplicated) 368 813 706.623806 $36344.6700 $51.4300
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 3 4 4.000000 $926.4800 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 62 270 170.155961 $8507.8400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 15 18 38.480161 $1924.0200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 5 11.211110 $280.2800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 38 44 140.111110 $7005.5500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 5 6 10.844443 $271.1100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 0.355556 $17.7800 $50.0100
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.788889 $44.7200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 14 15 21.954760 $1097.7400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 0.366666 $9.1700 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 16 17 206.428571 $5160.7200 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 240 586 6048.642838 $151216.0900 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 5 8 158.571427 $7928.5800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 571 685 12808.357118 $640417.9200 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1337 1874 30150.506300 $1507525.6000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1794 2535 42984.117384 $515809.5000 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 67 80 1086.857138 $78210.2700 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 25.857143 $1860.6800 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 16 21 189.714284 $10927.5500 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 190 307 4047.546827 $291261.4800 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 20.142857 $1449.4800 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 47 58 842.928571 $60657.1500 $71.9600
PHY -97110HM PT SESSION BY PT ASST 18 32 211.571425 $12178.0700 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 141 247 2902.785715 $208884.5300 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 21.714286 $1562.5600 $71.9600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 1.000000 $114.8100 $114.8100
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 1.000000 $229.6100 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 3 3.000000 $1377.6600 $459.2200
SENS -V5264 EARMOLD 5 7 7.000000 $126.9100 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 66 83 784.357140 $56442.3600 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 172 323 3489.171426 $251080.8500 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 2 4 39.642856 $2852.7100 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 11 15 131.642856 $1837.7400 $13.9600
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Subtotal (Total Children Is Unduplicated) 2122 7260 106563.824818 $3829316.8200 $35.9300
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Total 8293 107606.885921 $3865661.4900 $35.9200
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Number of Children (Unduplicated) With at Least One Authorization 2221