Summary Report for FSPSAs Initiated During the Report Period Center: 57
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: 10-01-23 and 12-31-23 Date of Report: 01-14-24 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 1801 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 9 9 3.900001 $145.0800 $37.2000
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Subtotal (Total Children Is Unduplicated) 9 9 3.900001 $145.0800 $37.2000
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 16 16 16.000000 $725.1200 $45.3200
OCTF -97168 OT RE-EVAL EST PLAN CARE 25 27 7.944443 $408.4200 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 14 14 6.633333 $341.0200 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 11 11 1.933333 $99.3900 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 13 13 6.444444 $331.3100 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 50 57 24.033334 $1235.5600 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.250000 $12.8500 $51.4100
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Subtotal (Total Children Is Unduplicated) 97 139 63.238887 $3153.6600 $49.8700
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 2 0.300000 $15.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 297 304 261.703182 $13085.2000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 33 33 42.546030 $2127.2900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 428 445 320.804774 $16040.3000 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 52 57 404.285720 $10107.1300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 577 610 4688.049248 $234402.3200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 59 60 290.928572 $20935.1900 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 3 5 21.142858 $1217.8300 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 36 37 93.571426 $6733.4000 $71.9600
PHY -97110HM PT SESSION BY PT ASST 1 1 8.571429 $493.3700 $57.5600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 70 80 409.714286 $29483.0100 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 4 5 36.571430 $2106.5100 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 6.571429 $472.8800 $71.9600
TRAV -TRAVS Travel by mile 13 13 69.338096 $30.8600 $0.4500
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Subtotal (Total Children Is Unduplicated) 621 1653 6654.098480 $337250.2800 $50.6800
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Total 1801 6721.237368 $340549.0200 $50.6700
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Number of Children (Unduplicated) With at Least One Authorization 629