Summary Report for FSPSAs Initiated During the Report Period Center: 10
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 1528 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
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 188 188 198.734921 $4668.2800 $23.4900
OCTH -97167 OT EVAL HIGH COMPLEXITY 15 15 14.700000 $750.4400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 12 12 11.688889 $596.7200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 6 6 6.000000 $306.3000 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 3 3 3.000000 $153.1500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 31 31 30.322222 $1350.8500 $44.5500
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Subtotal (Total Children Is Unduplicated) 239 255 264.446032 $7825.7400 $29.5900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 126 132 112.555551 $5627.7600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 11 12 11.544445 $577.2300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 62 64 42.961105 $2148.0300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 66 68 49.333335 $2466.6800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 420 447 3599.721046 $179986.0300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 12.857143 $642.8600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 35 35 199.357142 $14242.0600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 113 114 715.107144 $40904.1200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 197 198 965.414279 $68969.1700 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 0.571429 $40.8200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 26.857143 $1535.1600 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 1 1 2.928571 $209.2200 $71.4400
SENS -V5264 EARMOLD 1 1 1.000000 $18.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 178 181 1111.121428 $79378.4800 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 13.500000 $772.2000 $57.2000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 6.285714 $359.5400 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 12 12 91.960861 $1276.4200 $13.8800
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Subtotal (Total Children Is Unduplicated) 693 1273 6964.076336 $404153.7500 $58.0300
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Total 1528 7228.522368 $411979.4900 $56.9900
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Number of Children (Unduplicated) With at Least One Authorization 724