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: 10-01-20 and 12-31-20 Date of Report: 01-23-21 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1511 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 18 20 5.905554 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 18 20 5.905554 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 4 4 1.316667 $63.8600 $48.5000
NURS -T1001 NURSING ASSESSMENT 1 1 1.571429 $78.5700 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.005556 $0.2900 $51.4600
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.027778 $1.4200 $51.0900
OCTH -97167 OT EVAL HIGH COMPLEXITY 54 60 14.388890 $734.5600 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 47 53 11.588890 $591.6200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 27 32 6.683334 $341.1900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.222222 $11.3400 $51.0400
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 0.533333 $23.7600 $44.5500
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Subtotal (Total Children Is Unduplicated) 104 156 36.338099 $1846.6000 $50.8200
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 6 16 1.872222 $93.6100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 6 0.916668 $22.9200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2 2 1.000000 $50.0000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.333333 $8.3300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 4 4 1.683334 $84.1700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 1.903968 $47.6000 $25.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 1.250000 $31.2500 $25.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 2.226190 $55.6600 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 57 67 326.142861 $8153.5600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 465 509 3291.785733 $164589.2500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 6 7 48.571428 $2428.5800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 464 521 3333.546844 $33335.4700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 51 58 341.071433 $24366.1300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 18 19 88.142857 $5041.7600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 51 56 279.357145 $19957.2700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 10 13 73.714286 $4213.5000 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 1.000000 $57.1600 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 26 30 123.642859 $8833.0400 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 2 11.428571 $653.7200 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 12 13 66.142857 $918.0600 $13.8800
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Subtotal (Total Children Is Unduplicated) 569 1335 7995.732589 $272941.0300 $34.1400
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Total 1511 8037.976242 $274787.6300 $34.1900
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Number of Children (Unduplicated) With at Least One Authorization 588