Summary Report for FSPSAs Initiated During the Report Period Center: 09
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 640 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 26 26 41.173017 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 26 26 41.173017 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.333333 $7.8300 $23.5000
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Subtotal (Total Children Is Unduplicated) 1 1 0.333333 $7.8300 $23.5000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 98 155 238.071429 $11903.5700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 26 30 30.288889 $757.2200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 42 43 41.277777 $2063.8900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 36 38 36.338888 $1816.9400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 17 18 17.861110 $893.0500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 39 41 52.140475 $2607.0200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 132 142 820.204755 $41010.2900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 1.000000 $50.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 28 31 177.795236 $12701.7100 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 28 34 168.142854 $12012.1500 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 11.285714 $806.2500 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 68 77 498.661901 $35624.4300 $71.4400
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Subtotal (Total Children Is Unduplicated) 330 613 2095.069028 $127271.5100 $60.7500
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Total 640 2136.575378 $127279.3500 $59.5700
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Number of Children (Unduplicated) With at Least One Authorization 354