Summary Report for FSPSAs Initiated During the Report Period Center: 04
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: 01-01-16 and 03-31-16 Date of Report: 05-12-16 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1740 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 2 2 2.577778 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 2 2.577778 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 2 2 0.488889 $23.7100 $48.5000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 4 4 0.811110 $41.4000 $51.0400
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 46 48 26.324296 $1343.8600 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 11 11 2.988889 $152.5800 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 49 51 23.397076 $1194.4300 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.472222 $24.1100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 25 26 6.844443 $349.4000 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 12 12 3.581746 $182.8500 $51.0500
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Subtotal (Total Children Is Unduplicated) 124 155 64.908671 $3312.3400 $51.0300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.002740 $13.5000 $4927.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 33 77 21.932544 $1096.6500 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 7 7 5.994444 $299.7200 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 83 92 489.285705 $12232.1500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 544 578 3429.050266 $171452.6300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 527 574 3491.505507 $34915.0700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 82 83 352.035713 $25149.4500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 4 4 29.857142 $1707.8300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 71 75 390.142853 $27871.8100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 7 7 25.357143 $1449.4100 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 78 81 403.695232 $28840.0400 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 0.571429 $32.6800 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 8.928571 $123.9300 $13.8800
TRAV -TRAVS Travel by mile 1 1 3.857143 $1.7200 $0.4400
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Subtotal (Total Children Is Unduplicated) 679 1583 8652.216432 $305186.5800 $35.2700
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Total 1740 8719.702881 $308498.9100 $35.3800
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Number of Children (Unduplicated) With at Least One Authorization 680