Summary Report for FSPSAs Ending During the Report Period Center: 06
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: 07-01-24 and 09-30-24 Date of Report: 04-06-25 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1595 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 50 51 76.342064 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 50 51 76.342064 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT COS Exit 109 111 89.250000 $4462.5000 $50.0000
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Subtotal (Total Children Is Unduplicated) 109 111 89.250000 $4462.5000 $50.0000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 9 9 16.611112 $1151.9900 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.366667 $25.4300 $69.3600
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 89 94 96.676115 $4833.8100 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 31 33 27.725572 $1386.2800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 42 43 22.468020 $561.7100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 9 9 11.144446 $557.2300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 2.550000 $63.7500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 4 5 5.277778 $263.8900 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 1 1 0.155556 $7.7800 $50.0100
CONOP -CONOP CONSULT, OT, PHONE 2 2 3.883334 $97.0900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 0.333334 $16.6700 $50.0100
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.433333 $35.8300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2 2 2.400000 $120.0000 $50.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 10 13 190.000001 $4750.0000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 3 3 49.142857 $1326.8600 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 447 500 3182.647613 $171863.0800 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 29 31 151.214285 $8165.5900 $54.0000
INTR -T1013 INTERPRETER 41 54 261.290475 $13064.5200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 467 540 3423.033327 $41076.4300 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 9 10 62.080954 $5048.4200 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 0.500000 $40.6600 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 3 3 23.714285 $1544.2800 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 2 2 15.714285 $1023.3200 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 20 20 103.768253 $8438.4500 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 4 4 8.321429 $676.7000 $81.3200
PHY -97110HM PT SESSION BY PT ASST 8 8 40.578571 $2642.4800 $65.1200
PHY -97110HMGT PT SESSION BY PT ASST 4 4 27.428571 $1786.1500 $65.1200
SENS -V5264 EARMOLD 4 4 12.700000 $230.2500 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 22 23 130.214286 $10589.0200 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 7 8 59.178571 $4812.4000 $81.3200
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Subtotal (Total Children Is Unduplicated) 554 1433 7933.553030 $291200.0400 $36.7000
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Total 1595 8099.145094 $295662.5400 $36.5100
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Number of Children (Unduplicated) With at Least One Authorization 604