Summary Report for FSPSAs Ending During the Report Period Center: 57
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: 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 1705 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
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 0.411111 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 8 8 10.344446 $382.7500 $37.0000
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Subtotal (Total Children Is Unduplicated) 9 9 10.755557 $382.7500 $35.5900
Screening, Eval, and Assessment, Class # 02
OCTH -97167 OT EVAL HIGH COMPLEXITY 32 35 11.239682 $573.7900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 11 11 4.861112 $248.1600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 31 35 9.350793 $477.3600 $51.0500
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Subtotal (Total Children Is Unduplicated) 47 81 25.451587 $1299.3100 $51.0500
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 5 10 3.111109 $155.5500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 121 125 72.552378 $3627.6100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 18 19 10.394444 $519.7200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 255 270 119.572231 $5978.6600 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 53 60 299.268251 $7481.7100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 464 492 2970.466657 $148523.3400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 464 493 2963.247609 $29632.4800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 51 57 143.142860 $10226.1300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 5.714286 $326.8600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 26 26 87.357145 $6240.7900 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 55 62 167.642861 $11976.4100 $71.4400
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Subtotal (Total Children Is Unduplicated) 519 1615 6842.469831 $224689.2400 $32.8400
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Total 1705 6878.676975 $226371.3000 $32.9100
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Number of Children (Unduplicated) With at Least One Authorization 528