Summary Report for FSPSAs Initiated During the Report Period Center: 57
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 1469 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
TCM -T1017TL TARGETED CASE MANAGEMENT 12 12 6.566668 $244.2800 $37.2000
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Subtotal (Total Children Is Unduplicated) 12 12 6.566668 $244.2800 $37.2000
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 2.000000 $90.6400 $45.3200
OCTF -97168 OT RE-EVAL EST PLAN CARE 12 13 5.327778 $273.9000 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 9 9 5.372223 $276.1900 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 5 7 3.394444 $174.5100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 0.172222 $8.8500 $51.4000
SPCH -92521 EVAL OF SPEECH FLUENCY 33 39 27.727780 $1425.5000 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.455556 $23.4200 $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) 51 73 45.450003 $2317.8700 $51.0000
EI Services, Class # 03
CONOF -CONOF CONSULT, OT, FACE TO FACE 437 460 356.301588 $17815.0900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 55 60 63.758732 $3187.9500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 479 502 337.453967 $16872.7000 $50.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 3 3 40.285714 $2014.2900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 258 296 1919.268262 $95963.3500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 15 15 61.114287 $4397.7700 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 4 5 25.142856 $1809.2800 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 20 23 127.418255 $9169.0100 $71.9600
TRAV -TRAVS Travel by mile 19 20 107.755556 $47.9500 $0.4400
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Subtotal (Total Children Is Unduplicated) 662 1384 3038.499217 $151277.3800 $49.7900
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Total 1469 3090.515888 $153839.5300 $49.7800
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Number of Children (Unduplicated) With at Least One Authorization 678