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: 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 863 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 41 41 21.942857 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 41 41 21.942857 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 0.061111 $2.9600 $48.4900
AUD -92626 EVAL OF AUD REHAB STATUS 3 3 2.161111 $121.2400 $56.1000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.172222 $7.8000 $45.3100
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 1 0.333333 $17.1400 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 0.366667 $18.8500 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 2 0.361111 $18.5600 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 1 1 0.500000 $25.7100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 4 4 1.550001 $79.6900 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 0.188889 $9.7100 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 5 5 5.326190 $273.8200 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 6 6 1.355555 $69.6900 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 3 0.877777 $45.1200 $51.4100
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Subtotal (Total Children Is Unduplicated) 23 29 13.253967 $690.2900 $52.0800
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 34 90 22.861508 $1143.0800 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2 2 0.966666 $48.3300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 3 1.955555 $48.8900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 8 8 6.849999 $342.5000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 1.911111 $47.7800 $25.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.044444 $1.1100 $24.9800
CONSF -CONSF CONSULT, SLP, FACE TO FACE 5 5 5.471429 $273.5700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.011111 $0.2800 $24.9800
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 2 2 12.571428 $314.2900 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 2 2 20.142858 $503.5700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 61 64 580.142856 $29007.1300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 52 53 280.714288 $14035.7100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 518 542 4097.581752 $40975.7900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 9.428571 $678.4800 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 8.571429 $616.8000 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 4 4 39.857142 $2868.1200 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 7 7 39.285714 $2827.0000 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 5 5 36.857144 $2652.2400 $71.9600
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Subtotal (Total Children Is Unduplicated) 571 793 5165.225005 $96384.6400 $18.6600
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Total 863 5200.421829 $97074.9300 $18.6700
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Number of Children (Unduplicated) With at Least One Authorization 611