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: 07-01-19 and 09-30-19 Date of Report: 11-04-19 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2473 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 31 32 17.258729 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 31 32 17.258729 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 4 5 1.400000 $67.9000 $48.5000
OCTH -97167 OT EVAL HIGH COMPLEXITY 95 114 34.532539 $1762.8800 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 94 119 32.791275 $1674.0200 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.066667 $3.4100 $51.0700
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 26 27 6.655556 $339.7700 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 10 12 2.633333 $128.8700 $48.9400
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Subtotal (Total Children Is Unduplicated) 189 278 78.079370 $3976.8500 $50.9300
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 25 67 13.488893 $674.4700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1 1 0.233333 $11.6700 $49.9900
CONSP -CONSP CONSULT, SLP, PHONE 1 2 2.433334 $60.8400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 130 182 1041.857144 $26046.4200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 599 695 4690.511100 $234525.5500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 603 752 5002.635710 $50026.3500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 44 44 273.857141 $19564.3700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 102 136 623.246027 $35649.6500 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 43 48 262.285713 $18737.6900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 95 120 564.964296 $32293.3100 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 11 12 75.142857 $5368.1900 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 77 104 408.500002 $5669.9700 $13.8800
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Subtotal (Total Children Is Unduplicated) 768 2163 12959.155550 $428628.4700 $33.0800
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Total 2473 13054.493649 $432605.3200 $33.1400
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Number of Children (Unduplicated) With at Least One Authorization 795