Summary Report for FSPSAs Initiated During the Report Period Center: 57
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: 10-01-19 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 1660 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
TCM -T1017TL TARGETED CASE MANAGEMENT 9 9 13.577778 $502.3800 $37.0000
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Subtotal (Total Children Is Unduplicated) 9 9 13.577778 $502.3800 $37.0000
Screening, Eval, and Assessment, Class # 02
OCTH -97167 OT EVAL HIGH COMPLEXITY 40 41 27.783331 $1418.3300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 18 18 11.676983 $596.1000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 41 42 13.616664 $695.1200 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.166667 $8.1600 $48.9500
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Subtotal (Total Children Is Unduplicated) 55 102 53.243645 $2717.7000 $51.0400
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 3 5 1.672223 $83.6200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 135 136 73.335708 $3666.7600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 25 25 15.016666 $750.8300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 254 256 122.009518 $6100.4500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.622222 $15.5600 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 52 52 352.000000 $8800.0100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 471 478 3263.006340 $163150.3300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 468 477 3264.292055 $32642.9200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 48 48 168.785715 $12058.0400 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 20 20 88.642859 $6332.6300 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 50 50 170.500002 $12180.5100 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 6.357143 $88.2400 $13.8800
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Subtotal (Total Children Is Unduplicated) 514 1549 7526.240451 $245869.8900 $32.6700
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Total 1660 7593.061874 $249089.9700 $32.8000
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Number of Children (Unduplicated) With at Least One Authorization 519