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 520 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 -92652 AEP THRSHLD EST MLT FREQ I&R 6 7 7.000000 $525.9100 $75.1300
OCTH -97165 OT EVAL LOW COMPLEXITY 9 11 11.000000 $565.5100 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 10 11 11.000000 $565.5100 $51.4100
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Subtotal (Total Children Is Unduplicated) 23 29 29.000000 $1656.9300 $57.1400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 174 199 183.488886 $9174.4300 $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 23 25 218.733333 $10936.6700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 33 35 323.747616 $16187.3900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 14 14 43.049207 $3097.8300 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 8 9 28.500001 $2050.8500 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 24 28 162.642858 $11703.7800 $71.9600
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Subtotal (Total Children Is Unduplicated) 255 491 1142.407934 $67213.2600 $58.8300
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Total 520 1171.407934 $68870.1900 $58.7900
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Number of Children (Unduplicated) With at Least One Authorization 262