Summary Report for FSPSAs Ending During the Report Period Center: 04
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: 10-01-16 and 12-31-16 Date of Report: 02-04-17 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1820 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 3 1.055555 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 2 3 1.055555 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 9 9 3.100001 $150.3500 $48.5000
EVAL -96111 DEVELOPMENTAL EVALUATION 2 2 2.626027 $131.3000 $50.0000
NURS -T1001 NURSING ASSESSMENT 1 1 1.142857 $57.1500 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 6 6 1.699999 $86.7800 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 66 69 34.630953 $1767.9100 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 5 5 1.122222 $57.2900 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 62 65 28.768254 $1468.6200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 39 42 38.707142 $1975.9900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 5 5 0.866666 $44.2400 $51.0500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 146 204 112.664121 $5739.6300 $50.9400
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 18 53 10.005554 $500.2700 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4 4 6.108567 $305.4300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 2.577778 $128.8900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1 1 19.714286 $985.7200 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 85 100 602.714283 $15067.8600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 543 597 3641.970276 $182098.3900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 518 586 3552.169071 $35521.6600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 85 98 501.970641 $35860.7600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 16.428572 $939.7200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 83 89 555.357150 $39674.6700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 3 17.428572 $996.2100 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 66 77 350.500002 $25039.6900 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 11.000000 $629.2000 $57.2000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 686 1613 9287.944752 $337748.4500 $36.3600
-------------------------------------------------------------------------------------------------------------------------------------
Total 1820 9401.664428 $343488.0800 $36.5300
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 687