Summary Report for FSPSAs Initiated During the Report Period Center: 04
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: 04-01-23 and 06-30-23 Date of Report: 07-25-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 905 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
SCONLY-SCONLY *SERVICE COORDINATION ONLY 51 52 43.621429 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 51 52 43.621429 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 1.244444 $69.8100 $56.1000
OCTH -97167TL OT EVAL HIGH COMPLEXITY 9 9 3.005555 $154.5100 $51.4100
PSTF -97164TL PT RE-EVAL EST PLAN CARE 1 1 0.200000 $10.2800 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 12 13 3.605556 $185.3600 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 10 10 2.511111 $129.1000 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 2.000000 $102.8200 $51.4100
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Subtotal (Total Children Is Unduplicated) 26 37 12.566666 $651.8900 $51.8700
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 25 63 25.721425 $1286.0500 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 8 8 20.996827 $1049.8500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.033333 $25.8300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 10 10 5.134126 $256.7100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.033333 $25.8300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 0.355556 $17.7800 $50.0100
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4 4 0.411110 $20.5500 $49.9900
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 8 8 23.857142 $596.4300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 4 4 24.000000 $1200.0100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 118 120 925.999994 $46300.0600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 532 564 4167.022986 $50004.3300 $12.0000
OCCT -97530TL OT SESSION BY LICENSED OT 6 6 25.428570 $1829.8500 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 13 14 62.857144 $4523.2100 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 10 11 45.642857 $3284.4800 $71.9600
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Subtotal (Total Children Is Unduplicated) 589 816 5329.494403 $110420.9500 $20.7200
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Total 905 5385.682498 $111072.8300 $20.6200
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Number of Children (Unduplicated) With at Least One Authorization 632