Summary Report for FSPSAs Ending During the Report Period Center: 52
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 653 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 5 6 2.188889 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 6 2.188889 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SCREEN-T1023 SCREENING 3 3 3.000000 $150.0000 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 3.000000 $154.2300 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.8600 $44.8600
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Subtotal (Total Children Is Unduplicated) 7 8 8.000000 $400.5000 $50.0600
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 1 2.733333 $136.6700 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 216 259 614.107134 $30705.3100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 2 2 7.666666 $383.3300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 118 141 366.790478 $18339.5300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 65 77 207.533337 $10376.6900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 136 140 313.766668 $15688.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 4.366667 $109.1700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 5.285714 $264.2900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6 6 22.457143 $1122.8600 $50.0000
INTR -T1013 INTERPRETER 1 1 1.000000 $50.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 3 3 10.400000 $748.3800 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 3 3 11.628571 $836.7900 $71.9600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 2.000000 $115.1200 $57.5600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 0.266667 $19.1900 $71.9700
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Subtotal (Total Children Is Unduplicated) 263 639 1570.002378 $78895.6600 $50.2500
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Total 653 1580.191267 $79296.1600 $50.1800
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Number of Children (Unduplicated) With at Least One Authorization 269