Summary Report for FSPSAs Initiated During the Report Period Center: 03
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: 10-01-21 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 962 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 20 20 20.771428 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 20 20 20.771428 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 14 17 11.477778 $556.6700 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 3 3.000000 $86.1600 $28.7200
OCTH -97167 OT EVAL HIGH COMPLEXITY 21 27 14.183334 $724.0600 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 37 45 19.257919 $983.1400 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 49 55 34.482119 $1760.3300 $51.0500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 105 147 82.401150 $4110.3600 $49.8800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 14 16 12.877779 $64389.5000 $5000.0500
CONIF -CONIF CONSULT, ITDS FACE TO FACE 25 26 30.144446 $1507.2300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 60 67 76.533332 $3826.6600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 40 44 46.066668 $2303.3400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 94 113 122.239678 $6111.9700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 252 358 1471.336508 $73566.8700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 11.857143 $592.8600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 21 35 163.228570 $11661.0700 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 41 62 254.438097 $18177.0500 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 53 73 253.642859 $18120.2800 $71.4400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 384 795 2442.365080 $200256.8100 $81.9900
-------------------------------------------------------------------------------------------------------------------------------------
Total 962 2545.537658 $204367.1700 $80.2800
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 401