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: 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 2147 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 0.800000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 2 0.800000 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 6 6 3.611111 $175.1400 $48.5000
OCTH -97167 OT EVAL HIGH COMPLEXITY 105 111 37.004763 $1889.0900 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 2 0.516666 $26.3700 $51.0400
PSTH -97163 PT EVAL HIGH COMPLEXITY 105 110 34.372219 $1754.6900 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 67 70 16.666664 $850.8200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 2 2 0.455556 $23.2600 $51.0500
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Subtotal (Total Children Is Unduplicated) 210 301 92.626979 $4719.3700 $50.9500
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 35 75 14.272226 $713.6300 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 6 6 3.055556 $152.7800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 4 4 2.327779 $116.4000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 1.155556 $57.7800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2 2 1.277777 $63.8900 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 91 95 504.000007 $12600.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 587 629 4815.000030 $240749.8900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 558 628 4689.749237 $46897.4700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 144 152 821.571439 $58692.9700 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 132 136 906.999997 $64796.0900 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 109 114 491.071432 $35082.1100 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 10.000000 $138.8000 $13.8800
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Subtotal (Total Children Is Unduplicated) 748 1844 12260.481036 $460061.7900 $37.5200
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Total 2147 12353.908015 $464781.1600 $37.6200
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Number of Children (Unduplicated) With at Least One Authorization 750