Summary Report for FSPSAs Initiated During the Report Period Center: 04
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: 04-01-23 and 06-30-23 Date of Report: 07-25-23 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1369 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 42 43 32.147619 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 42 43 32.147619 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
OCTH -97167 OT EVAL HIGH COMPLEXITY 3 3 1.138889 $58.5500 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 20 23 5.528569 $284.2200 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 2 0.650000 $33.4200 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 23 25 17.359525 $892.4600 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 17 18 4.006348 $205.9600 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.122222 $6.2800 $51.4000
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.200000 $10.2800 $51.4100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 0.133333 $6.8500 $51.4000
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 2 2 6.857143 $352.5200 $51.4100
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Subtotal (Total Children Is Unduplicated) 51 77 35.996029 $1850.5500 $51.4100
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 22 55 24.115870 $1205.7800 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 6 6 10.226985 $511.3500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.033333 $25.8300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 9 9 5.078570 $253.9300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.033333 $25.8300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 0.355556 $17.7800 $50.0100
CONSF -CONSF CONSULT, SLP, FACE TO FACE 5 5 2.177777 $108.8900 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 82 103 428.714284 $10717.8600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 32 33 243.571427 $12178.5900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 401 431 3110.428545 $155521.5800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 418 446 3262.617437 $39151.4500 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 18.142858 $1305.5600 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 47 51 287.571429 $20693.6500 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 2 2 16.714286 $1202.7600 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 42 46 227.142856 $16345.2400 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 2 12.285715 $884.0800 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 49 53 229.285714 $16499.4200 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 1.642857 $118.2200 $71.9600
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Subtotal (Total Children Is Unduplicated) 524 1249 7882.138832 $276767.7700 $35.1100
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Total 1369 7950.282480 $278618.3200 $35.0500
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Number of Children (Unduplicated) With at Least One Authorization 556