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 1402 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 -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 1.000000 $19.5100 $19.5100
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 27 28 28.000000 $2103.6400 $75.1300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 4 3.777777 $188.8900 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 30 35 35.000000 $1799.3500 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 5 5 5.000000 $257.0500 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 37 40 39.044444 $2007.2700 $51.4100
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Subtotal (Total Children Is Unduplicated) 93 113 111.822221 $6375.7100 $57.0200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 3.000000 $15000.0000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 260 297 277.077775 $13853.8800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 27 27 33.195238 $1659.7700 $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 71 76 803.114289 $40155.7100 $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 263 310 1897.106334 $94855.3300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 80 92 660.013488 $47494.5900 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 55 61 318.992861 $22954.7000 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 142 169 1004.042854 $72250.9600 $71.9600
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Subtotal (Total Children Is Unduplicated) 647 1289 5240.119826 $320403.7900 $61.1400
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Total 1402 5351.942047 $326779.5000 $61.0600
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Number of Children (Unduplicated) With at Least One Authorization 665