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: 01-01-18 and 03-31-18 Date of Report: 05-05-18 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 782 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 10 12 3.866664 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 10 12 3.866664 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 11 11 3.349087 $162.4300 $48.5000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 0.116667 $5.9600 $51.0600
OCTH -97167 OT EVAL HIGH COMPLEXITY 7 8 1.638889 $83.6700 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 0.188889 $9.6400 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 0.338889 $17.3000 $51.0500
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Subtotal (Total Children Is Unduplicated) 21 24 5.632421 $278.9900 $49.5300
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 18 43 9.372225 $468.6300 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 16 17 7.022225 $351.1300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 13 15 5.594446 $279.7300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 4 4 1.933334 $96.6700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 6 7 2.388890 $119.4500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 41 43 314.285713 $15714.3000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 524 599 4217.543640 $42175.4400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 11 12 55.785713 $3985.3200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 2 2 13.857143 $989.9500 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4 4 18.285715 $1306.3200 $71.4400
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Subtotal (Total Children Is Unduplicated) 547 746 4646.069044 $65486.9300 $14.1000
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Total 782 4655.568129 $65765.9200 $14.1300
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Number of Children (Unduplicated) With at Least One Authorization 558