Summary Report for FSPSAs Ending During the Report Period Center: 57
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: 01-01-22 and 03-31-22 Date of Report: 04-16-22 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 887 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 5 5 2.088889 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 5 2.088889 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $55.7100 $55.7100
OCTH -97167 OT EVAL HIGH COMPLEXITY 12 12 3.938891 $201.0900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 3 3 0.583334 $29.7800 $51.0600
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 10 10 2.772224 $141.5300 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 3.313492 $147.6200 $44.5500
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Subtotal (Total Children Is Unduplicated) 15 28 11.607941 $575.7300 $49.6000
EI Services, Class # 03
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $230.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 2 0.877778 $43.8900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 221 228 219.884123 $10994.2000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.033333 $0.8300 $24.9800
CONPF -CONPF CONSULT, PT, FACE TO FACE 37 40 47.940474 $2397.0100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 254 263 201.006348 $10050.3200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.066667 $1.6700 $25.0100
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 8 8 43.403175 $2170.1600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 307 310 2054.126994 $20541.2600 $10.0000
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Subtotal (Total Children Is Unduplicated) 367 854 2568.338892 $46429.3400 $18.0800
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Total 887 2582.035722 $47005.0700 $18.2000
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Number of Children (Unduplicated) With at Least One Authorization 382