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
Eligibility Filter: Program Patients
With the filters selected there were 3749 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 3 3 3.000000 $47.5200 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 1.000000 $19.5100 $19.5100
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 430 441 439.800000 $33042.1700 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.000000 $45.3200 $45.3200
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 4 3.777777 $188.8900 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 4.571429 $235.0200 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 119 142 156.360320 $8038.4900 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 25 27 26.855556 $1380.6500 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 146 170 158.244444 $8135.3400 $51.4100
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Subtotal (Total Children Is Unduplicated) 650 790 794.609526 $51132.9100 $64.3500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 9 9.000000 $45000.0000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 262 299 280.011108 $14000.5400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 28 28 33.839682 $1691.9900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 74 77 68.639683 $3431.9900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 166 176 166.794447 $8339.7400 $50.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 75 80 853.864289 $42693.2100 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 8.142857 $407.1500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 775 933 5814.721793 $290736.1700 $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 367 420 2526.049203 $181774.6000 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 293 326 1706.221427 $122779.7400 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 500 607 3569.899986 $256890.1700 $71.9600
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Subtotal (Total Children Is Unduplicated) 1339 2959 15055.749554 $968673.5300 $64.3400
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Total 3749 15850.359080 $1019806.4400 $64.3400
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Number of Children (Unduplicated) With at Least One Authorization 1404