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: 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 849 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 14 8.905555 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 14 14 8.905555 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 23 36 18.066060 $876.2100 $48.5000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.0500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 2 2 1.261111 $64.3800 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 2 1.072222 $54.7400 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 7 9 4.950000 $252.7000 $51.0500
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Subtotal (Total Children Is Unduplicated) 32 50 26.349393 $1299.0700 $49.3000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 1.444444 $7222.0000 $4999.8500
CONIF -CONIF CONSULT, ITDS FACE TO FACE 215 241 549.592065 $27479.6100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 94 105 228.246824 $11412.3400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 102 114 220.364285 $11018.2100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 216 250 440.025400 $22001.3000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 30 31 112.439683 $5621.9800 $50.0000
INTR -T1013 INTERPRETER 18 18 141.645238 $7082.2700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 5 34.142858 $2439.1500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 5 6 36.623811 $2616.4000 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 9 12 72.390477 $5171.5800 $71.4400
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Subtotal (Total Children Is Unduplicated) 309 785 1836.915085 $102064.8200 $55.5600
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Total 849 1872.170033 $103363.8900 $55.2100
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Number of Children (Unduplicated) With at Least One Authorization 327