Summary Report for FSPSAs Initiated During the Report Period Center: 04
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: 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 1427 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 29 32 16.488889 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 29 32 16.488889 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 5 5 1.716667 $83.2600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $56.4900 $56.4900
OCTH -97167 OT EVAL HIGH COMPLEXITY 55 57 11.944444 $609.7600 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.261111 $13.3300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 47 48 20.398409 $1041.3200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 29 31 6.199998 $316.5000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 4 0.766667 $34.1600 $44.5500
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Subtotal (Total Children Is Unduplicated) 100 147 42.287296 $2154.8200 $50.9600
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 7 18 5.249996 $262.4800 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3 4 2.400000 $120.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3 4 3.322222 $166.1100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1 1 1.011111 $50.5600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.000000 $25.0000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 75 110 478.571432 $11964.2500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 390 418 2797.142868 $139857.1300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 8.142857 $407.1500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 375 408 2667.246040 $26672.4600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 43 46 234.357140 $16742.4800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 39 55 210.714281 $12052.8800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 52 61 292.642855 $20906.4200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 23 31 142.357142 $8137.1400 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 16 16 65.642856 $4689.5200 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 10 14 57.071429 $3264.4800 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 33 46 171.071425 $2374.4800 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 10 14 50.178571 $1856.6200 $37.0000
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Subtotal (Total Children Is Unduplicated) 502 1248 7188.122225 $249549.1400 $34.7200
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Total 1427 7246.898410 $251703.9600 $34.7300
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Number of Children (Unduplicated) With at Least One Authorization 523