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 1638 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 -92552 PURE TONE AUDIOMETRY -AIR ONLY 11 12 12.000000 $234.1200 $19.5100
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 67 69 89.428571 $6718.7700 $75.1300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.633333 $31.6700 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 35 46 66.758730 $3432.0600 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 3 6 6.000000 $308.4600 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 42 52 58.098413 $2986.8400 $51.4100
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Subtotal (Total Children Is Unduplicated) 137 186 232.919047 $13711.9200 $58.8700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.000000 $10000.0000 $5000.0000
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 152 178 168.722222 $8436.1100 $50.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 233 263 1937.650802 $96882.5300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 133 144 798.223806 $39911.1900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 126 144 829.351588 $59680.1300 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 104 120 496.609920 $35736.0300 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 201 246 1432.395241 $103075.1600 $71.9600
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Subtotal (Total Children Is Unduplicated) 714 1451 6003.859929 $370666.4600 $61.7400
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Total 1638 6237.201198 $384378.3900 $61.6300
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Number of Children (Unduplicated) With at Least One Authorization 773