Summary Report for FSPSAs Ending During the Report Period Center: 10
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: 01-01-23 and 03-31-23 Date of Report: 04-20-23 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 677 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 4 5 5.000000 $97.5500 $19.5100
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 28 30 30.000000 $2253.9000 $75.1300
OCTH -97165 OT EVAL LOW COMPLEXITY 14 18 17.733333 $911.6700 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 2 2.000000 $102.8200 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 11 12 12.000000 $616.9200 $51.4100
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Subtotal (Total Children Is Unduplicated) 51 67 66.733333 $3982.8600 $59.6800
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 1 0.866667 $43.3400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 146 182 166.144443 $8307.2200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 9 12 15.844443 $792.2200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 48 54 47.222223 $2361.1200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 94 111 108.122222 $5406.1100 $50.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 31 34 156.034918 $7801.7500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 19 19 123.414283 $6170.7300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 60 66 372.244446 $26786.7000 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 53 60 259.513494 $18674.5800 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 61 71 373.035718 $26843.6500 $71.9600
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Subtotal (Total Children Is Unduplicated) 311 610 1622.442857 $103187.3900 $63.6000
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Total 677 1689.176190 $107170.2500 $63.4500
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Number of Children (Unduplicated) With at Least One Authorization 343