Summary Report for FSPSAs Ending During the Report Period Center: 57
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 1397 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
TCM -T1017TL TARGETED CASE MANAGEMENT 18 19 13.141267 $488.8500 $37.2000
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Subtotal (Total Children Is Unduplicated) 18 19 13.141267 $488.8500 $37.2000
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 3.000000 $135.9600 $45.3200
OCTF -97168 OT RE-EVAL EST PLAN CARE 14 14 5.150000 $264.7600 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 10 10 7.955556 $409.0000 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 7 7 1.377779 $70.8400 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 5 5 1.327777 $68.2600 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 31 33 18.894444 $971.3600 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 2.472223 $127.1000 $51.4100
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Subtotal (Total Children Is Unduplicated) 60 76 40.177779 $2047.2800 $50.9600
EI Services, Class # 03
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1 2 0.566666 $28.3300 $49.9900
CONOF -CONOF CONSULT, OT, FACE TO FACE 412 429 287.877774 $14393.8700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 65 67 66.793652 $3339.6800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 448 470 274.884921 $13744.2500 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 11.142857 $278.5700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 2 2 11.285714 $564.2900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 242 275 1588.485708 $79424.3100 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 13 13 63.714286 $4584.8700 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 6 7 44.428571 $3197.0800 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 17 17 137.428571 $9889.3800 $71.9600
TRAV -TRAVS Travel by mile 18 19 87.649205 $39.0000 $0.4400
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Subtotal (Total Children Is Unduplicated) 640 1302 2574.257925 $129483.6300 $50.3000
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Total 1397 2627.576971 $132019.7500 $50.2400
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Number of Children (Unduplicated) With at Least One Authorization 675