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: 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 2417 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 27 28 14.603175 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 27 28 14.603175 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 2 3 0.527778 $25.6000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 2.000000 $112.9800 $56.4900
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.194444 $9.9200 $51.0400
OCTH -97167 OT EVAL HIGH COMPLEXITY 97 107 47.477778 $2423.7300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 98 116 40.105553 $2047.3800 $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 30 32 6.650001 $339.4900 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 12 12 3.161112 $154.7100 $48.9400
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Subtotal (Total Children Is Unduplicated) 193 274 100.183333 $5117.2100 $51.0800
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 24 60 14.027774 $701.3700 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1 1 0.155556 $7.7800 $50.0100
CONOF -CONOF CONSULT, OT, FACE TO FACE 1 1 0.222222 $11.1100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 3 3 0.611111 $30.5600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.366667 $34.1700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 143 195 1101.000004 $27525.0600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 618 689 4854.142905 $242707.1800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 628 736 5143.368312 $51433.6800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 41 41 263.571432 $18829.5300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 80 115 513.142859 $29351.7900 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 53 56 322.794454 $23060.3900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 75 103 528.857152 $30229.4800 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 12 13 44.928572 $3209.6900 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 66 101 405.285722 $5625.3600 $13.8800
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Subtotal (Total Children Is Unduplicated) 793 2115 13193.474742 $432757.1400 $32.8000
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Total 2417 13308.261250 $437874.3500 $32.9000
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Number of Children (Unduplicated) With at Least One Authorization 821