Summary Report for FSPSAs Ending During the Report Period Center: 07
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 859 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 21 21 32.038889 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 21 21 32.038889 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 1.000000 $13.7100 $13.7100
EXIT -EXIT EXIT ASSESSMENT 45 45 67.256165 $3362.8100 $50.0000
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 2 1.388889 $70.9000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 48 49 70.645054 $3498.4700 $49.5200
EI Services, Class # 03
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.000000 $68.8600 $68.8600
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 106 145 105.910523 $5295.5700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 12 12 12.227779 $305.7000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 259 292 732.375596 $36618.7900 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 1.466667 $73.3400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 4 5.500000 $137.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 120 128 273.147622 $13657.3900 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 2 2 6.300000 $315.0000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 49 51 119.514289 $5975.7300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 131 139 309.528578 $15476.4500 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 1 1 3.428571 $171.4300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.166667 $29.1700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 8 9 94.142858 $4707.1500 $50.0000
PHY -97110 PT SESSION BY LICENSED PT 1 1 5.857143 $418.4300 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 5.857143 $418.4300 $71.4400
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Subtotal (Total Children Is Unduplicated) 331 789 1677.423436 $83668.9100 $49.8800
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Total 859 1780.107379 $87167.3800 $48.9700
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Number of Children (Unduplicated) With at Least One Authorization 367