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: 07-01-22 and 06-30-23 Date of Report: 07-25-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 6119 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 49 51 59.941271 $2229.8200 $37.2000
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Subtotal (Total Children Is Unduplicated) 49 51 59.941271 $2229.8200 $37.2000
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 10 10 10.000000 $453.2000 $45.3200
OCTF -97168 OT RE-EVAL EST PLAN CARE 35 50 32.116667 $1651.1200 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 39 39 50.033336 $2572.2300 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 2 2 0.394444 $20.2800 $51.4000
PSTF -97164 PT RE-EVAL EST PLAN CARE 12 20 11.172223 $574.3700 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 15 15 11.891270 $611.3300 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 1.016667 $52.2700 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 0.222222 $11.4200 $51.4000
SPCH -92521 EVAL OF SPEECH FLUENCY 85 136 102.777780 $5283.8200 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 0.571429 $29.3800 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 8 12 9.194444 $472.6800 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 1.755556 $90.2600 $51.4100
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Subtotal (Total Children Is Unduplicated) 141 290 232.146038 $11873.7600 $51.1500
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 3 1.766667 $88.3400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1 6 3.311112 $165.5600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1337 1922 3502.359494 $175117.8300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 163 250 698.877776 $34943.8700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1509 2121 3432.897574 $171644.6600 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 32 35 123.785709 $3094.6400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 6 7 137.857142 $6892.8600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 679 1154 16393.580938 $819679.1700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 45 64 637.500000 $45874.5100 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 1 1 19.428571 $1119.0900 $57.6000
OCCT -97530TLGTHM OT SESSION BY OT ASST 1 2 20.285714 $1168.4600 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 20 31 240.357142 $17296.1300 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 76 114 1464.428568 $105380.3700 $71.9600
TRAV -TRAVS Travel by mile 46 67 1058.128572 $470.8700 $0.4500
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Subtotal (Total Children Is Unduplicated) 1950 5778 27735.564979 $1382986.3400 $49.8600
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Total 6119 28027.652288 $1397089.9100 $49.8500
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Number of Children (Unduplicated) With at Least One Authorization 1980