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: 04-01-20 and 06-30-20 Date of Report: 07-20-20 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2018 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 37 39 16.833335 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 37 39 16.833335 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 4 4 2.077778 $100.7700 $48.5000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 0.283333 $14.4600 $51.0400
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.450000 $22.9700 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 86 93 22.088888 $1127.6300 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.311111 $15.8800 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.061111 $3.1200 $51.0400
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.261111 $13.3300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 63 65 17.979364 $917.8400 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.500000 $25.5300 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.172222 $8.7900 $51.0400
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 43 49 12.780952 $652.4700 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.255556 $13.0500 $51.0600
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 0.277778 $12.3800 $44.5500
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Subtotal (Total Children Is Unduplicated) 156 222 57.499204 $2928.2200 $50.9300
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 20 51 9.822222 $491.1100 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3 4 1.144445 $57.2300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 4 5 2.244445 $112.2300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1 1 0.933333 $46.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.000000 $25.0000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 94 132 688.999995 $17225.0200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 532 587 3725.152380 $186257.6400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 2 7.857142 $392.8600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 521 590 3681.451588 $36814.5300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 72 77 442.284132 $31596.7600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 58 76 325.571431 $18622.6800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 57 62 299.999999 $21431.9900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 45 55 245.607145 $14038.9000 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 23 24 163.285716 $11665.1300 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 18 25 107.428574 $6144.9100 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 43 57 206.285716 $2863.2500 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 7 8 47.428570 $1754.8600 $37.0000
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Subtotal (Total Children Is Unduplicated) 683 1757 9956.496833 $349540.7500 $35.1100
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Total 2018 10030.829372 $352468.9700 $35.1400
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Number of Children (Unduplicated) With at Least One Authorization 709