Summary Report for FSPSAs Ending During the Report Period Center: 03
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: 10-01-19 and 12-31-19 Date of Report: 02-01-20 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 778 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 67 73 45.613242 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 67 73 45.613242 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 18 21 13.885235 $673.4300 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.000000 $27.8300 $27.8300
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 0.166667 $8.5100 $51.0600
PSTH -97163 PT EVAL HIGH COMPLEXITY 4 5 2.749848 $140.3800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 5 6 2.544444 $129.8900 $51.0500
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Subtotal (Total Children Is Unduplicated) 28 34 20.346194 $980.0500 $48.1700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 1.322222 $6611.0000 $4999.9200
CONIF -CONIF CONSULT, ITDS FACE TO FACE 202 213 271.525402 $13576.3000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 91 104 119.634130 $5981.7300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 85 95 118.955557 $5947.7900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 202 221 226.795242 $11339.7800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 22 24 100.365076 $5018.2500 $50.0000
PHY -97110 PT SESSION BY LICENSED PT 6 7 30.709524 $2193.8900 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 5 5 18.290475 $1306.6800 $71.4400
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Subtotal (Total Children Is Unduplicated) 294 671 887.597628 $51975.4000 $58.5600
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Total 778 953.557064 $52955.4500 $55.5300
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Number of Children (Unduplicated) With at Least One Authorization 366