Summary Report for FSPSAs Ending During the Report Period Center: 57
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 5817 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 17 17 37.466668 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 50 57 71.085714 $2644.3900 $37.2000
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Subtotal (Total Children Is Unduplicated) 67 74 108.552382 $2644.3900 $24.3600
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 10 10 10.000000 $453.2000 $45.3200
OCTF -97168 OT RE-EVAL EST PLAN CARE 33 45 31.577776 $1623.4000 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 1.266667 $65.1200 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 41 41 50.677781 $2605.3600 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 2 2 0.394444 $20.2800 $51.4000
PSTF -97164 PT RE-EVAL EST PLAN CARE 16 21 12.199999 $627.2000 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 15 15 13.557936 $697.0100 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 1.016667 $52.2700 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 0.222222 $11.4200 $51.4000
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 86 127 108.849208 $5595.9400 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 0.571429 $29.3800 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 14 18 11.466666 $589.5000 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 6 4.083334 $209.9300 $51.4100
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Subtotal (Total Children Is Unduplicated) 152 291 246.884129 $12631.4200 $51.1600
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 13.571429 $3143.4100 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 2 4 2.050000 $102.5000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1 4 2.577778 $128.8900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1190 1780 3535.541248 $176776.9900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 158 244 711.040476 $35552.0100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1379 2003 3445.029346 $172251.3500 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 24 28 145.571430 $3639.2900 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 4 5 96.428571 $4821.4300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 672 1112 16524.063509 $826203.1700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 15 15 181.571428 $2178.8600 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 44 59 549.984130 $39576.8300 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 3 4 29.714286 $1711.5400 $57.6000
OCCT -97530TLGTHM OT SESSION BY OT ASST 1 2 20.285714 $1168.4600 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 15 21 211.357143 $15209.2600 $71.9600
PHY -97110HM PT SESSION BY PT ASST 3 3 23.285715 $1340.3200 $57.5600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 69 101 1322.428574 $95161.9500 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 5.571429 $400.9200 $71.9600
TRAV -TRAVS Travel by mile 43 64 981.734920 $436.8700 $0.4400
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Subtotal (Total Children Is Unduplicated) 1816 5452 27802.807126 $1379854.0300 $49.6300
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Total 5817 28158.243637 $1395129.8400 $49.5500
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Number of Children (Unduplicated) With at Least One Authorization 1861