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: 10-01-17 and 12-31-17 Date of Report: 02-03-18 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 933 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 14 15 6.022221 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 14 15 6.022221 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 19 36 15.219332 $738.1500 $48.5000
OCTH -97167 OT EVAL HIGH COMPLEXITY 5 5 3.266667 $166.7700 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 3 3 2.027778 $103.5200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 13 14 9.088889 $463.9900 $51.0500
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Subtotal (Total Children Is Unduplicated) 35 58 29.602666 $1472.4200 $49.7400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 215 251 473.761902 $23688.0800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 115 130 212.043650 $10602.1900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 108 125 185.949206 $9297.4600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 237 268 410.750007 $20537.5400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 29 34 107.004764 $5350.2600 $50.0000
INTR -T1013 INTERPRETER 19 22 116.367463 $5818.3800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 5 5 44.000000 $3143.3500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 5 5 19.285714 $1377.7700 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 18 19 135.533334 $9682.5100 $71.4400
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Subtotal (Total Children Is Unduplicated) 346 860 1705.696040 $94497.5300 $55.4000
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Total 933 1741.320927 $95969.9500 $55.1100
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Number of Children (Unduplicated) With at Least One Authorization 365