Summary Report for FSPSAs Initiated During the Report Period Center: 53
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 767 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 15 16 21.144445 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 15 16 21.144445 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 9 9 8.205556 $397.9700 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 5 5 2.127777 $46.9600 $22.0700
BEHV -BEHV BEHAVIORAL ASSESSMENT 2 2 1.428571 $178.5800 $125.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 1.000000 $75.0000 $75.0000
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Subtotal (Total Children Is Unduplicated) 17 17 12.761904 $698.5000 $54.7300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 3.627778 $18139.0000 $5000.0300
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 8 11 8.000000 $400.0000 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 8 10 9.966667 $498.3400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4 4 4.077778 $203.8900 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 1 1 1.200000 $60.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 44 49 52.133334 $2606.6700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.783333 $19.5800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 22 22 21.538889 $1076.9500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 29 32 36.431746 $1821.5900 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 2 2 2.500000 $125.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 17.285715 $432.1400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 6.714286 $335.7200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 29 30 173.047617 $8652.3800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 448 546 2448.705550 $29384.4700 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 6 6 25.497617 $1834.8100 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 3.428571 $246.7200 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 1 1 4.285714 $308.4000 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 8 9 44.971427 $3236.1600 $71.9600
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Subtotal (Total Children Is Unduplicated) 458 734 2864.196022 $69381.8100 $24.2200
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Total 767 2898.102371 $70080.3200 $24.1800
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Number of Children (Unduplicated) With at Least One Authorization 471