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 1245 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 -92652 AEP THRSHLD EST MLT FREQ I&R 27 30 30.000000 $2253.9000 $75.1300
OCTH -97165 OT EVAL LOW COMPLEXITY 15 17 17.000000 $873.9700 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 2 2.000000 $102.8200 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 13 14 13.166667 $676.9000 $51.4100
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Subtotal (Total Children Is Unduplicated) 51 63 62.166667 $3907.5900 $62.8600
EI Services, Class # 03
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 579 667 5432.013089 $271600.6800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 40 46 354.964283 $25543.2500 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 36 42 215.823018 $15530.6100 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 49 55 367.104766 $26416.8400 $71.9600
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Subtotal (Total Children Is Unduplicated) 665 1182 6734.044065 $357297.5900 $53.0600
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Total 1245 6796.210732 $361205.1800 $53.1500
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Number of Children (Unduplicated) With at Least One Authorization 677