Summary Report for FSPSAs Initiated During the Report Period Center: 10
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
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2394 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
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 7 7 7.000000 $136.5700 $19.5100
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 271 303 308.532289 $23180.0300 $75.1300
OCTH -97165 OT EVAL LOW COMPLEXITY 46 65 65.000000 $3341.6500 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 11 15 15.000000 $771.1500 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 58 75 74.415874 $3825.7200 $51.4100
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Subtotal (Total Children Is Unduplicated) 363 465 469.948163 $31255.1200 $66.5100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 11.428571 $57143.0000 $5000.0100
CONIF -CONIF CONSULT, ITDS FACE TO FACE 168 198 188.811121 $9440.6100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 24 27 37.827779 $1891.4000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 45 45 41.466670 $2073.3500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 99 101 96.000006 $4800.0300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.033333 $0.8300 $24.9800
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 596 684 5479.242850 $273962.1800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1 1 4.285714 $214.2900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 208 268 1821.611901 $131083.2300 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 221 265 1433.217464 $103134.3200 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 271 338 2324.708855 $167286.0400 $71.9600
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Subtotal (Total Children Is Unduplicated) 914 1929 11438.634264 $751029.2700 $65.6600
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Total 2394 11908.582427 $782284.3900 $65.6900
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Number of Children (Unduplicated) With at Least One Authorization 942