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: 10-01-18 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 2287 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 13 15 19.980954 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 13 15 19.980954 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 4 5 1.422222 $68.9800 $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 0.194444 $9.9200 $51.0400
OCTH -97167 OT EVAL HIGH COMPLEXITY 107 109 41.430155 $2114.9900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 92 100 56.861108 $2902.7500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 50 51 23.038887 $1176.1300 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 6 6 2.172222 $106.3100 $48.9400
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Subtotal (Total Children Is Unduplicated) 203 273 126.119038 $6435.5600 $51.0300
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 41 115 21.883326 $1094.1300 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 6 7 5.455557 $272.7900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1 1 5.357143 $267.8600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 5 6 5.100001 $255.0100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2 2 0.850000 $42.5000 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 119 124 760.857151 $19021.4300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 636 668 5285.571474 $264278.6100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 626 700 5565.115922 $55651.1700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 77 77 547.349214 $39102.6500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 72 74 334.357146 $19125.2300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 57 57 409.357150 $29244.4400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 66 70 362.071435 $20696.0000 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 28 28 144.867065 $10349.3000 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 70 70 290.285716 $4029.1600 $13.8800
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Subtotal (Total Children Is Unduplicated) 797 1999 13738.478300 $463430.2500 $33.7300
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Total 2287 13884.578292 $469865.8100 $33.8400
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Number of Children (Unduplicated) With at Least One Authorization 809