Summary Report for FSPSAs Initiated During the Report Period Center: 10
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: 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 2323 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 -92550 TYMPANOMETRY & REFLEX THRESH 2 2 2.000000 $31.6800 $15.8400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 280 289 287.800000 $21622.4100 $75.1300
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 4.571429 $235.0200 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 68 81 96.193652 $4945.3200 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 13 15 15.000000 $771.1500 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 84 101 90.722222 $4664.0300 $51.4100
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Subtotal (Total Children Is Unduplicated) 410 489 496.287303 $32269.6100 $65.0200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 4 4.000000 $20000.0000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 175 200 185.188886 $9259.4300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 17 17 25.884127 $1294.2100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 58 59 53.639683 $2681.9900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 100 104 101.722223 $5086.1200 $50.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 25 27 238.340476 $11917.0300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 535 645 4200.540854 $210027.1100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 3 18.565079 $928.2600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 227 254 1459.870637 $105052.3500 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 177 194 1089.549993 $78404.0700 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 272 327 1969.964276 $141758.7200 $71.9600
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Subtotal (Total Children Is Unduplicated) 841 1834 9347.266234 $586409.2800 $62.7400
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Total 2323 9843.553537 $618678.8800 $62.8500
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Number of Children (Unduplicated) With at Least One Authorization 883