Summary Report for FSPSAs Initiated During the Report Period Center: 03
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: 10-01-21 and 12-31-21 Date of Report: 02-04-22 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 745 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 35 35 28.638096 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 35 35 28.638096 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 17 20 13.966667 $677.3900 $48.5000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.123288 $14.1800 $115.0100
PSTH -97163 PT EVAL HIGH COMPLEXITY 10 13 8.738888 $446.1200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 12 14 12.776983 $652.2600 $51.0500
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Subtotal (Total Children Is Unduplicated) 36 48 35.605826 $1789.9400 $50.2700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 5 4.101066 $20505.5000 $5000.0400
CONIF -CONIF CONSULT, ITDS FACE TO FACE 32 33 37.900002 $1895.0100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 102 116 144.110317 $7205.5100 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 1 1 0.355556 $17.7800 $50.0100
CONPF -CONPF CONSULT, PT, FACE TO FACE 64 73 75.888891 $3794.4600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 158 189 217.095235 $10854.7500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 153 214 1026.168251 $51308.4400 $50.0000
PHY -97110 PT SESSION BY LICENSED PT 10 14 96.119048 $6866.7400 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 15 17 78.307936 $5594.3200 $71.4400
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Subtotal (Total Children Is Unduplicated) 388 662 1680.046302 $108042.5100 $64.3100
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Total 745 1744.290224 $109832.4500 $62.9700
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Number of Children (Unduplicated) With at Least One Authorization 422