Summary Report for FSPSAs Initiated During the Report Period Center: 10
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 1421 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 5 5 3.588889 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 5 3.588889 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 43 43 43.000000 $918.0500 $21.3500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 5 6 6.000000 $306.3000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 7 8 8.000000 $408.4000 $51.0500
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Subtotal (Total Children Is Unduplicated) 52 58 58.000000 $1683.8000 $29.0300
EI Services, Class # 03
CONIF -CONIF CONSULT, ITDS FACE TO FACE 549 582 368.119829 $18405.9300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 62 63 41.055558 $2052.7900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 109 112 79.899998 $3994.9900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 409 417 259.582531 $12979.0800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 58 71 480.220634 $24011.0300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 27 29 132.285714 $9450.5000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 34 35 168.928569 $12068.2700 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 46 49 289.892859 $20709.9300 $71.4400
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Subtotal (Total Children Is Unduplicated) 650 1358 1819.985692 $103672.5200 $56.9600
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Total 1421 1881.574581 $105356.3200 $55.9900
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Number of Children (Unduplicated) With at Least One Authorization 665