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: 10-01-18 and 12-31-18 Date of Report: 02-06-19 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2245 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 8 9 9.850793 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 8 9 9.850793 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 8 8 2.755556 $133.6500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $56.4900 $56.4900
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.427778 $21.8400 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 114 117 66.307937 $3385.0300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 107 117 34.885716 $1780.9300 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.355556 $18.1500 $51.0600
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 58 61 20.927777 $1068.3600 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 0.183334 $8.9800 $48.9600
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Subtotal (Total Children Is Unduplicated) 229 308 126.843654 $6473.4200 $51.0300
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 26 83 15.427779 $771.4000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 6 7 7.555556 $377.7800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2 2 1.314286 $65.7200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 7 8 7.627778 $381.3900 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 109 130 722.142846 $18053.5900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 590 642 4634.857124 $231742.8400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 583 672 4902.176974 $49021.7600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 121 126 740.938888 $52932.6900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 26 29 80.071427 $4580.1000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 111 115 677.142850 $48375.1000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 16 17 43.071428 $2461.9700 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 67 70 321.857143 $22993.5100 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 24 27 76.285715 $1058.8500 $13.8800
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Subtotal (Total Children Is Unduplicated) 755 1928 12230.469794 $432816.6900 $35.3900
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Total 2245 12367.164241 $439290.1100 $35.5200
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Number of Children (Unduplicated) With at Least One Authorization 765