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 1997 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 59 62 62.000000 $4658.0600 $75.1300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.133333 $56.6700 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 34 37 36.966667 $1900.4600 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 3 4 4.000000 $205.6400 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 39 45 44.166667 $2270.6100 $51.4100
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Subtotal (Total Children Is Unduplicated) 119 149 148.266667 $9091.4300 $61.3200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $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 227 265 240.816678 $12040.8900 $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 814 942 7300.506747 $365025.3400 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 99 109 769.071421 $55342.4200 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 75 86 443.532539 $31916.5800 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 170 191 1270.739684 $91442.4400 $71.9600
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Subtotal (Total Children Is Unduplicated) 1031 1848 10278.417874 $573404.4300 $55.7900
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Total 1997 10426.684541 $582495.8700 $55.8700
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Number of Children (Unduplicated) With at Least One Authorization 1055