Summary Report for FSPSAs Initiated During the Report Period Center: 52
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 683 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 3 3 2.255555 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 3 3 2.255555 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 3 3 3.000000 $150.0000 $50.0000
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 4 4.000000 $204.2000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 2.000000 $102.1000 $51.0500
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Subtotal (Total Children Is Unduplicated) 8 9 9.000000 $456.3000 $50.7000
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 2.200000 $110.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 2 2 1.866667 $93.3400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 230 250 513.971422 $25698.5400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 130 148 345.966662 $17298.3100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 62 73 162.538092 $8126.8900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 171 178 358.504759 $17925.2200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 3.166667 $79.1700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6 6 22.919048 $1145.9500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 7.904762 $564.7100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 4.714286 $269.6600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 2 2 2.266667 $161.9300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 4.571429 $261.3000 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4 4 18.485715 $1320.6200 $71.4400
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Subtotal (Total Children Is Unduplicated) 307 671 1449.076176 $73055.6300 $50.4200
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Total 683 1460.331731 $73511.9300 $50.3400
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Number of Children (Unduplicated) With at Least One Authorization 313