Summary Report for FSPSAs Initiated During the Report Period Center: 07
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: 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 753 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 8.799206 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 5 8.799206 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 3 3 2.211111 $30.5400 $13.8100
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.4100 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 6 6 5.416667 $278.4700 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.4100 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.4100 $51.4100
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Subtotal (Total Children Is Unduplicated) 12 12 10.627778 $463.2400 $43.5900
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 132 176 143.916678 $7195.8900 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 3 3 3.000000 $150.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 4 4 3.750000 $93.7500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 216 247 588.914277 $29445.6700 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 3 4 9.166666 $458.3300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 98 106 215.590475 $10779.5200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 35 37 63.838094 $3191.9000 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 1 1 0.866667 $43.3400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 113 125 256.590475 $12829.5200 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 2 2 3.233333 $161.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.400000 $35.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 16 18 146.447620 $7322.3800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 22.000000 $1583.1200 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 7 7 53.142858 $3824.1600 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 2 6.285715 $362.0600 $57.6000
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Subtotal (Total Children Is Unduplicated) 297 736 1519.142858 $77501.2800 $51.0200
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Total 753 1538.569842 $77964.5200 $50.6700
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Number of Children (Unduplicated) With at Least One Authorization 304