Summary Report for FSPSAs Ending During the Report Period Center: 03
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: 10-01-22 and 12-31-22 Date of Report: 01-23-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 607 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 53 55 29.422221 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 53 55 29.422221 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 20 21 14.994444 $727.2300 $48.5000
OCTH -97165 OT EVAL LOW COMPLEXITY 4 5 1.355556 $69.6900 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 0.169863 $8.7300 $51.4200
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.488889 $25.1300 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 3 3 2.172222 $111.6700 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 14 15 9.777778 $502.6800 $51.4100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 37 46 28.958752 $1445.1400 $49.9000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.000000 $10000.0000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 26 26 23.266666 $1163.3300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 69 79 83.622218 $4181.0900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 56 59 59.888888 $2994.4400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 110 116 110.792068 $5539.6300 $50.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 10.714286 $535.7200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 172 193 734.228576 $36711.4200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 5 6 36.923811 $2657.0400 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 5 5 25.304762 $1820.9300 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 17 19 76.195239 $5483.0100 $71.9600
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 354 506 1162.936514 $71086.6000 $61.1300
-------------------------------------------------------------------------------------------------------------------------------------
Total 607 1221.317487 $72531.7400 $59.3900
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 412