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
Eligibility Filter: Program Patients
With the filters selected there were 4222 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 1 1 0.422222 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 0.422222 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 2 2 2.000000 $31.6800 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 86 90 90.000000 $1755.9000 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 3 3 3.000000 $71.0100 $23.6700
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 468 506 559.593347 $42042.2400 $75.1300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.633333 $31.6700 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 113 140 175.107935 $9002.2900 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.733333 $37.7000 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 17 25 24.511111 $1260.1200 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 145 180 188.762818 $9704.3000 $51.4100
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Subtotal (Total Children Is Unduplicated) 699 948 1044.341877 $63936.9000 $61.2200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 5 19.142857 $95714.5000 $5000.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 1 0.866667 $43.3400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 215 263 241.516668 $12075.8400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 18 23 37.856348 $1892.8200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 60 67 58.666667 $2933.3400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 152 179 169.622222 $8481.1100 $50.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 247 288 1992.500009 $99624.9700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 724 837 5813.817868 $290690.9500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 3 3 2.565079 $128.2600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 347 480 2764.765874 $198952.5300 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 308 412 1951.439283 $140425.5200 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 519 715 4119.471437 $296437.1200 $71.9600
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Subtotal (Total Children Is Unduplicated) 1386 3273 17172.230979 $1147400.2800 $66.8200
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Total 4222 18216.995078 $1211337.1800 $66.4900
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Number of Children (Unduplicated) With at Least One Authorization 1646