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: 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 763 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 102 103 110.142857 $2587.2600 $23.4900
OCTH -97167 OT EVAL HIGH COMPLEXITY 15 15 15.000000 $765.7500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 3 3 3.000000 $153.1500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 18 18 17.933333 $915.5000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 3.000000 $133.6500 $44.5500
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Subtotal (Total Children Is Unduplicated) 131 142 149.076190 $4555.3000 $30.5600
EI Services, Class # 03
CONIF -CONIF CONSULT, ITDS FACE TO FACE 57 57 83.382540 $4169.1300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 10 10 9.488889 $474.4500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 22 22 21.627777 $1081.3900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 29 29 34.633334 $1731.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.533333 $13.3300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 219 232 2545.089281 $127254.4700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 47 47 401.068252 $28652.3200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 18 18 130.107142 $7442.1300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 85 85 570.321426 $40743.7900 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 4.785714 $341.8900 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 111 114 795.992066 $56865.7000 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 13.285714 $759.9500 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 60.714286 $842.7100 $13.8800
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Subtotal (Total Children Is Unduplicated) 356 621 4671.029754 $270372.9100 $57.8800
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Total 763 4820.105944 $274928.2200 $57.0400
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Number of Children (Unduplicated) With at Least One Authorization 384