Summary Report for FSPSAs Ending During the Report Period Center: 10
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 3764 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 0.833333 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 0.833333 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $56.1000 $56.1000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 336 375 374.066667 $7298.0400 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 4 4 4.000000 $94.6800 $23.6700
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 217 229 229.000000 $17204.7700 $75.1300
OCTH -97165 OT EVAL LOW COMPLEXITY 99 118 112.311112 $5773.9200 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 15 17 15.855556 $815.1400 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 101 128 121.544444 $6248.6000 $51.4100
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Subtotal (Total Children Is Unduplicated) 634 872 857.777779 $37491.2400 $43.7100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.000000 $10000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 1 1.000000 $50.0000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 205 253 262.979764 $13149.0100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 29 33 25.066667 $1253.3400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 61 66 53.677778 $2683.8900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 139 150 165.274604 $8263.7400 $50.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 12.285714 $307.1400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 843 976 7115.205192 $355760.2900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 2 2 5.285714 $264.2900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 289 375 2374.469056 $170866.6500 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 307 401 1960.558731 $141081.5900 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 470 631 3687.877917 $265379.4800 $71.9600
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Subtotal (Total Children Is Unduplicated) 1300 2891 15665.681137 $969059.4100 $61.8600
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Total 3764 16524.292249 $1006550.6500 $60.9100
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Number of Children (Unduplicated) With at Least One Authorization 1554