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: 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 639 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 66 67 47.733332 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 66 67 47.733332 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 7 8 6.516666 $316.0600 $48.5000
OCTH -97165 OT EVAL LOW COMPLEXITY 7 7 2.799999 $143.9400 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 1.144444 $58.8300 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 7 8 5.116665 $263.0400 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 10 12 7.630158 $392.2600 $51.4100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 26 37 23.207932 $1174.1300 $50.5900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 3.066667 $15333.5000 $5000.0500
CONIF -CONIF CONSULT, ITDS FACE TO FACE 15 15 18.194446 $909.7300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 87 107 98.255554 $4912.7700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 51 53 49.144443 $2457.2200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 104 110 106.700005 $5335.0300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 187 204 765.100005 $38254.9700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 7 7 46.285715 $3330.7100 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 15 17 40.661905 $2926.0300 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 17 18 64.533332 $4643.8200 $71.9600
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 361 535 1191.942072 $78103.7700 $65.5300
-------------------------------------------------------------------------------------------------------------------------------------
Total 639 1262.883336 $79277.9000 $62.7800
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 426