Summary Report for FSPSAs Initiated During the Report Period Center: 03
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 635 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 38 38 21.300000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 38 38 21.300000 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 6 6 6.832540 $331.3800 $48.5000
OCTH -97165 OT EVAL LOW COMPLEXITY 7 7 3.644445 $187.3600 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 5 5 2.405556 $123.6700 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 5 6 4.144444 $213.0600 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.4100 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 15 17 9.222223 $474.1200 $51.4100
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Subtotal (Total Children Is Unduplicated) 31 42 27.249208 $1381.0000 $50.6800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.161111 $805.5000 $4999.6600
CONIF -CONIF CONSULT, ITDS FACE TO FACE 22 23 24.977778 $1248.8900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 102 126 149.033332 $7451.6600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 42 49 60.003171 $3000.1400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 99 110 141.055556 $7052.7800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 148 195 867.342851 $43367.1700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 7 7 20.952380 $1507.7300 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 16 20 53.257144 $3832.4000 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 21 24 89.328570 $6428.0900 $71.9600
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Subtotal (Total Children Is Unduplicated) 342 555 1406.111893 $74694.3600 $53.1200
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Total 635 1454.661101 $76075.3600 $52.3000
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Number of Children (Unduplicated) With at Least One Authorization 383