Summary Report for FSPSAs Ending During the Report Period Center: 03
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 604 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 68 70 31.955554 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 68 70 31.955554 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 10 10 8.216667 $398.5100 $48.5000
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 1 1 1.000000 $55.5000 $55.5000
OCTH -97165 OT EVAL LOW COMPLEXITY 5 5 1.605556 $82.5400 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 0.327777 $16.8500 $51.4000
PSTH -97163 PT EVAL HIGH COMPLEXITY 3 3 0.627777 $32.2700 $51.4000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 12 15 6.844444 $351.8700 $51.4100
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Subtotal (Total Children Is Unduplicated) 27 36 18.622221 $937.5400 $50.3500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 2.200000 $11000.0000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 10 11 12.444445 $622.2300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 88 100 98.877778 $4943.8900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 38 44 42.222224 $2111.1200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 111 123 129.360317 $6468.0100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 161 184 660.325399 $33016.2600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 7 7 20.066667 $1444.0000 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 8 8 23.580953 $1696.8900 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 15 17 37.669840 $2710.7200 $71.9600
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Subtotal (Total Children Is Unduplicated) 338 498 1026.747623 $64013.1100 $62.3500
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Total 604 1077.325398 $64950.6500 $60.2900
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Number of Children (Unduplicated) With at Least One Authorization 411