Summary Report for FSPSAs Ending During the Report Period Center: 02
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: 10-01-21 and 12-31-21 Date of Report: 02-04-22 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1215 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
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 19 21 16.767352 $813.2200 $48.5000
EXIT -EXIT EXIT ASSESSMENT 32 32 38.285714 $1914.2900 $50.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.455556 $20.3000 $44.5500
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Subtotal (Total Children Is Unduplicated) 52 57 58.508622 $2900.9500 $49.5800
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 32 32 25.313775 $1265.6900 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 4 5 7.000000 $350.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 4 4 2.755556 $68.8900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 157 186 281.155950 $14057.7900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 79 84 124.647619 $6232.3800 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 16 16 25.709525 $1285.4900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 2.333333 $58.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 15 15 20.814288 $1040.7300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 4.733333 $118.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 135 153 237.733330 $11886.6500 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 2 2 5.066667 $253.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.033333 $0.8300 $24.9800
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 4 4 38.714286 $1935.7200 $50.0000
INTR -T1013 INTERPRETER 14 21 48.340964 $2417.0500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 168 291 1248.457148 $12484.5700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 5.714286 $408.2300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1 1 1.000000 $71.4400 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 5.714286 $408.2300 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 11.714286 $162.5900 $13.8800
TRAV -TRAVS Travel by mile 184 336 65589.253753 $29187.2200 $0.4500
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Subtotal (Total Children Is Unduplicated) 225 1158 67686.205718 $83693.4800 $1.2400
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Total 1215 67744.714340 $86594.4300 $1.2800
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Number of Children (Unduplicated) With at Least One Authorization 231