Summary Report for FSPSAs Initiated During the Report Period Center: 53
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: 07-01-22 and 09-30-22 Date of Report: 10-19-22 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 594 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 11 11 13.211111 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 11 11 13.211111 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 5 5 3.372222 $163.5500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 11.571429 $649.1600 $56.1000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 3 3 2.400000 $46.8200 $19.5100
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Subtotal (Total Children Is Unduplicated) 9 9 17.343651 $859.5300 $49.5600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 2.550000 $12750.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 5 5 2.193650 $109.6800 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 2 2 1.285714 $64.2900 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 6 6 8.302380 $415.1200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 48 48 51.490477 $2574.5300 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 2 2 1.733333 $86.6700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 25 25 27.983334 $1399.1700 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 1 1 1.000000 $50.0000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 19 19 17.744442 $887.2100 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 2 2 2.000000 $100.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 4.966667 $124.1700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 13 14 73.058730 $3652.9500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 9 10 78.866667 $3943.3300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 4 4 35.000000 $1750.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 340 421 1885.981749 $18859.8200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 3 3 26.999999 $1942.9200 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 12.428571 $894.3600 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 2 17.142857 $1233.6000 $71.9600
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Subtotal (Total Children Is Unduplicated) 349 574 2250.728570 $50837.8000 $22.5900
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Total 594 2281.283332 $51697.3300 $22.6600
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Number of Children (Unduplicated) With at Least One Authorization 360