Summary Report for FSPSAs Initiated During the Report Period Center: 54
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: 01-01-20 and 03-31-20 Date of Report: 05-15-20 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1964 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 5 5 4.544444 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 5 5 4.544444 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 29 33 35.788889 $1735.7600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 8 8 7.044444 $397.9400 $56.4900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 0.383333 $9.0800 $23.7000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 4 4 3.155556 $267.7200 $84.8400
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 6 6.000000 $270.0000 $45.0000
EXIT -EXIT EXIT ASSESSMENT 48 51 64.209872 $3210.5000 $50.0000
SCREEN-T1023 SCREENING 8 8 5.355556 $267.7800 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 99 113 121.937650 $6158.7900 $50.5100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 16 17 25.688889 $128444.5000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.544444 $27.2200 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 4.666667 $334.1800 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.166667 $11.9400 $71.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 97 107 93.766671 $4688.3600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 5 3.255556 $81.3900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 47 54 50.605556 $2530.2800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 81 82 61.379783 $3068.9900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.691667 $17.2900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 68 69 55.205554 $2760.2700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 109 111 80.559524 $4027.9800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 3.088889 $77.2200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 358 383 2273.275392 $113663.7800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 28 28 73.557143 $3677.8600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 490 850 3093.265119 $30932.6500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 46 49 308.193653 $22017.3400 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 3 3 8.714286 $622.5500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 10.222222 $584.7100 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 1.000000 $57.2000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 28 32 139.170635 $9942.3700 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 4 4 4.933333 $352.4400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 5 5 20.683334 $1182.2600 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 31 33 170.341268 $12169.1800 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 5.266667 $376.2500 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 13.085714 $181.6300 $13.8800
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 513 1846 6501.328633 $341829.8400 $52.5800
-------------------------------------------------------------------------------------------------------------------------------------
Total 1964 6627.810727 $347988.6200 $52.5000
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 521