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 3929 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 1 1 0.466667 $22.6400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 9 10 8.405555 $471.5500 $56.1000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.172222 $7.8000 $45.3100
OCTH -97165 OT EVAL LOW COMPLEXITY 5 6 2.772223 $142.5200 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 3 4 3.677778 $189.0800 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 4 4 2.144444 $110.2400 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 20 22 13.327778 $685.1800 $51.4100
PSTF -97164TL PT RE-EVAL EST PLAN CARE 1 1 0.200000 $10.2800 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 4 4 7.057144 $362.8100 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 2 2 1.066667 $54.8400 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 7 8 6.611112 $339.8800 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 28 33 17.327780 $890.8300 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 7 9 9.595238 $493.2900 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 28 34 20.502381 $1054.0300 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 0.761111 $39.1300 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 2 3 2.450001 $125.9600 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 4 5 2.983334 $153.3800 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 2.000000 $102.8200 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 3.285714 $168.9200 $51.4100
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Subtotal (Total Children Is Unduplicated) 87 151 104.807149 $5425.1800 $51.7600
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
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 36 42 123.373014 $6168.6400 $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 12 13 18.259522 $912.9700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 0.366666 $9.1700 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 3 3 17.428571 $435.7100 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 24 26 188.714285 $4717.8600 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 4 6 134.714285 $6735.7200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 108 126 2354.571419 $117728.5900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 299 393 6233.130146 $311656.5900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1793 2533 42929.117384 $515149.5000 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 5 58.000001 $4173.6700 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 1 1 20.285714 $1168.4600 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 17 19 270.499999 $19465.1900 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 9 10 241.857143 $17404.0400 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 28 31 318.500000 $22919.2700 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 10 11 136.357143 $9812.2600 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 26 33 502.285712 $36144.5100 $71.9600
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Subtotal (Total Children Is Unduplicated) 1907 3558 53781.297124 $1085697.8600 $20.1900
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Total 3929 54222.541570 $1091123.0400 $20.1200
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Number of Children (Unduplicated) With at Least One Authorization 2020