Summary Report for FSPSAs Ending During the Report Period Center: 52
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: 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 725 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 1 1 0.588889 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 0.588889 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 1 1 1.000000 $50.0000 $50.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 5 5 5.000000 $254.2000 $50.8400
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 0.700000 $35.0000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 230 278 547.683328 $27384.1400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.750000 $18.7500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 137 163 405.499997 $20274.9900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 67 71 157.066667 $7853.3400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 169 181 352.516661 $17625.8100 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 1 1 1.733333 $86.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.633333 $15.8300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6 7 34.752383 $1737.6200 $50.0000
INTR -T1013 INTERPRETER 3 3 9.790476 $489.5300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 0.833334 $59.5400 $71.4500
OCCT -97530HM OT SESSION BY OT ASST 1 1 0.714286 $40.8600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 2 2 6.695238 $478.3100 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 6 6 31.009524 $2215.3200 $71.4400
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Subtotal (Total Children Is Unduplicated) 284 719 1550.378560 $78315.6800 $50.5100
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Total 725 1555.967449 $78569.8800 $50.5000
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Number of Children (Unduplicated) With at Least One Authorization 286