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: 10-01-19 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 2184 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 26 26 12.933335 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 26 26 12.933335 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 2 2 0.550000 $26.6800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 2.000000 $112.9800 $56.4900
OCTF -97168 OT RE-EVAL EST PLAN CARE 2 2 0.505556 $25.8100 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.138889 $7.0900 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 97 104 27.326189 $1395.0000 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 2 0.261111 $13.3300 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.055556 $2.8400 $51.0900
PSTH -97163 PT EVAL HIGH COMPLEXITY 85 89 35.490476 $1811.8000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 36 39 9.135714 $466.3800 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.094444 $4.8200 $51.0300
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 11 11 3.283333 $160.6800 $48.9400
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Subtotal (Total Children Is Unduplicated) 183 254 78.841268 $4027.4000 $51.0800
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 21 82 17.867462 $893.3900 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1 1 0.100000 $5.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1 1 0.433333 $21.6700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 0.533333 $26.6700 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 112 131 812.142841 $20303.5900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 603 657 4517.142817 $225857.2900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 594 684 4667.381703 $46673.8500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 45 49 324.857136 $23207.8100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 78 87 429.285712 $24555.1700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 38 41 225.285710 $16094.4300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 76 84 456.392854 $26087.4500 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 10 10 61.071429 $4362.9400 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 63 75 336.361905 $4668.7000 $13.8800
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Subtotal (Total Children Is Unduplicated) 766 1904 11848.856235 $392757.9300 $33.1500
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Total 2184 11940.630838 $396785.3300 $33.2300
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Number of Children (Unduplicated) With at Least One Authorization 794