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
Eligibility Filter: Program Patients
With the filters selected there were 3585 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 10 10 10.000000 $195.1000 $19.5100
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 430 467 471.759686 $35443.3100 $75.1300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.133333 $56.6700 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 84 109 106.611111 $5480.8800 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 17 21 21.000000 $1079.6100 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 109 139 135.851643 $6984.1400 $51.4100
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Subtotal (Total Children Is Unduplicated) 589 747 746.355773 $49239.6900 $65.9700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 12.428571 $62143.0000 $5000.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 1 1.000000 $50.0000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 228 266 243.450011 $12172.5600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 35 40 49.694447 $2484.7400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 59 60 52.450003 $2622.5200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 147 152 149.573022 $7478.6900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.033333 $0.8300 $24.9800
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 840 970 7383.965079 $369198.2600 $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 312 392 2601.857134 $187229.7000 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 318 369 1935.288098 $139263.3100 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 474 584 3910.915202 $281429.4600 $71.9600
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Subtotal (Total Children Is Unduplicated) 1356 2838 16344.940614 $1064287.3300 $65.1100
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Total 3585 17091.296387 $1113527.0300 $65.1500
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Number of Children (Unduplicated) With at Least One Authorization 1408