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: 01-01-22 and 03-31-22 Date of Report: 04-16-22 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 825 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 42 42 47.846035 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 42 42 47.846035 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 2 2 0.672222 $32.6000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $55.7100 $55.7100
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 0.316667 $16.1700 $51.0600
OCTH -97167 OT EVAL HIGH COMPLEXITY 5 6 3.626983 $185.1500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 4 4 1.277778 $65.2300 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 0.138889 $7.0900 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.472222 $24.1100 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.172222 $7.6700 $44.5400
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Subtotal (Total Children Is Unduplicated) 16 19 7.676983 $393.7300 $51.2900
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 11.285714 $777.1300 $68.8600
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 14 35 8.605558 $430.2900 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5 6 2.777777 $138.8900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.711111 $17.7800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3 4 1.622222 $81.1100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 1.355555 $33.8900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1 1 0.511111 $25.5600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1 1 0.466667 $23.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 1.577778 $39.4500 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 12.000000 $300.0000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 5 5 22.571429 $1128.5700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 80 84 609.714275 $30485.7500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 7 7 32.000000 $1600.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 563 595 3975.503122 $39755.0600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 3 3 10.428572 $745.0100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 5 6 28.428570 $1626.1200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 3 3 32.428571 $2316.7000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 9.428571 $538.9400 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 2 13.428571 $959.3400 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 4.428571 $61.4700 $13.8800
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Subtotal (Total Children Is Unduplicated) 588 764 4780.273745 $81134.3700 $16.9700
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Total 825 4835.796763 $81528.1000 $16.8600
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Number of Children (Unduplicated) With at Least One Authorization 625