Summary Report for FSPSAs Ending During the Report Period Center: 10
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 1741 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 236 238 244.858729 $5751.7300 $23.4900
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 26 26 25.722222 $1313.1200 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 13 13 12.611111 $643.8000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 3.000000 $153.1500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 27 27 24.033333 $1226.9000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 15 15 15.000000 $668.2500 $44.5500
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Subtotal (Total Children Is Unduplicated) 290 323 326.225395 $9808.0000 $30.0700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 147 147 137.773023 $6888.6900 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 4.600000 $230.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 19 19 17.655556 $882.7800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 79 79 50.416675 $2520.8800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 72 73 59.074606 $2953.7500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.744444 $18.6100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 503 521 3788.786487 $189439.3400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 11.142857 $557.1500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 47 48 249.357143 $17814.0600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 98 100 535.107142 $30608.1500 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 206 210 954.535713 $68192.1200 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 3 3 17.500000 $1250.2000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 10.857143 $620.5900 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 195 203 1146.939685 $81937.4100 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 3 10.214286 $584.2600 $57.2000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 7.000000 $400.4000 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 6 6 15.428570 $214.1500 $13.8800
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Subtotal (Total Children Is Unduplicated) 751 1418 7018.133330 $410112.5200 $58.4400
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Total 1741 7344.358725 $419920.5100 $57.1800
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Number of Children (Unduplicated) With at Least One Authorization 799