Summary Report for FSPSAs Ending During the Report Period Center: 03
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 382 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 36 36 18.027779 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 36 36 18.027779 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 16 20 14.288888 $693.0100 $48.5000
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 3 2.072222 $105.7900 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 1.983334 $101.2500 $51.0500
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Subtotal (Total Children Is Unduplicated) 20 26 18.344444 $900.0500 $49.0600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 2 2.000000 $10000.0000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 24 28 41.988889 $2099.4500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 77 83 85.490476 $4274.5200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 50 53 49.799997 $2489.9900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 113 131 123.919045 $6195.9400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 12 14 55.276192 $2763.8100 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 2.100000 $150.0200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 2 3 17.857143 $1275.7100 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 5 5 21.885714 $1563.5100 $71.4400
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Subtotal (Total Children Is Unduplicated) 233 320 400.317456 $30812.9500 $76.9700
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Total 382 436.689679 $31712.9900 $72.6200
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Number of Children (Unduplicated) With at Least One Authorization 273