Summary Report for FSPSAs Ending During the Report Period Center: 53
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: 07-01-23 and 09-30-23 Date of Report: 10-10-23 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 847 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 12 12 14.466668 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 12 12 14.466668 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 4 4 4.000000 $194.0000 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 28 28 13.383334 $295.3700 $22.0700
EXIT -EXIT COS Exit 1 1 1.000000 $50.0000 $50.0000
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 5.857143 $301.1100 $51.4100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 33 34 24.240477 $840.4900 $34.6700
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 1 1 0.666667 $28.2700 $42.4100
ASST -ASST ASSISTIVE TECHNOLOGY 2 3 2.433333 $12166.5000 $4999.9300
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 1.133333 $262.4900 $231.6100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 5 7 19.642856 $982.1500 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 5 5 3.883333 $194.1700 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3 3 0.883334 $44.1700 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 1 1 0.900000 $45.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 36 39 46.561109 $2328.0500 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 3 3 5.000000 $250.0000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 15 15 21.769841 $1088.4900 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 2 2 2.666666 $133.3300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 19 20 23.222223 $1161.1200 $50.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 2 2 12.447619 $622.3800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 195 213 991.461110 $49573.0100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 16 16 57.780953 $2889.0600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 290 367 1565.766663 $18789.1900 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 20 22 139.404764 $10031.5700 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 4.000000 $287.8400 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 13 13 86.666668 $6236.5300 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 21 22 125.695237 $9045.0300 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 9 10 57.057143 $4105.8300 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 14 16 63.714286 $4584.8700 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 2.733333 $196.6900 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 16 16 79.625396 $5729.8400 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 3.611111 $259.8500 $71.9600
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 315 801 3318.726978 $131035.4000 $39.4800
-------------------------------------------------------------------------------------------------------------------------------------
Total 847 3357.434123 $131875.8900 $39.2800
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 323