Summary Report for FSPSAs Ending During the Report Period Center: 03
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: 10-01-23 and 12-31-23 Date of Report: 01-14-24 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 772 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 31 33 20.438889 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 31 33 20.438889 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 5 5 12.738096 $617.8000 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.166667 $4.8200 $28.9300
OCTH -97165 OT EVAL LOW COMPLEXITY 8 8 3.938890 $202.5000 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 14 14 8.933333 $459.2600 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 27 28 18.938891 $973.6600 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 45 49 40.391270 $2076.5200 $51.4100
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Subtotal (Total Children Is Unduplicated) 91 105 85.107147 $4334.5600 $50.9300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 6 3.661112 $18306.0000 $5000.1200
CONIF -CONIF CONSULT, ITDS FACE TO FACE 18 19 23.266667 $1163.3400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 74 82 99.522218 $4976.0900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 23 27 27.166664 $1358.3200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 49 54 53.522219 $2676.1000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 287 312 1290.757150 $64537.8700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 18 22 97.714285 $7031.5300 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 46 50 203.212699 $14623.2000 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 57 62 261.076188 $18787.0600 $71.9600
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Subtotal (Total Children Is Unduplicated) 411 634 2059.899202 $133459.4900 $64.7900
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Total 772 2165.445238 $137794.0500 $63.6300
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Number of Children (Unduplicated) With at Least One Authorization 444