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 595 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 210 211 217.858729 $5117.5000 $23.4900
OCTH -97167 OT EVAL HIGH COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 1.000000 $51.0500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 2.000000 $89.1000 $44.5500
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Subtotal (Total Children Is Unduplicated) 215 217 223.858729 $5410.8000 $24.1700
EI Services, Class # 03
CONIF -CONIF CONSULT, ITDS FACE TO FACE 146 146 136.139690 $6807.0300 $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 21 21 164.500001 $8225.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 4 25.571428 $1826.8300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 4 5 20.999999 $1201.2100 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 10 10 61.428570 $4388.4700 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 17 18 104.600001 $7472.6200 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 4.714286 $269.6600 $57.2000
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Subtotal (Total Children Is Unduplicated) 190 378 650.445256 $36796.8100 $56.5700
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Total 595 874.303985 $42207.6100 $48.2800
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Number of Children (Unduplicated) With at Least One Authorization 363