Summary Report for FSPSAs Initiated During the Report Period Center: 54
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: 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 698 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 11 11 10.371429 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 11 11 10.371429 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 64 74 76.094444 $3690.5800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 5 5 6.000000 $370.2600 $61.7100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.433333 $10.5200 $24.2800
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 0.700000 $31.7200 $45.3200
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Subtotal (Total Children Is Unduplicated) 70 82 83.227777 $4103.0800 $49.3000
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 1 1 0.477778 $22.9100 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 25 30 44.233333 $221166.5000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 175 190 144.621034 $7231.0700 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 14 16 17.178571 $858.9300 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 38 44 54.950792 $2747.5300 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 1 1 0.005556 $0.2800 $50.4000
CONOF -CONOF CONSULT, OT, FACE TO FACE 86 88 102.119840 $5105.9700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 1.800000 $45.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 51 52 54.447614 $2722.3600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 114 123 137.319047 $6865.9300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 2.555555 $63.8900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 30 31 135.141272 $7297.6100 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 3 3 18.857143 $1018.2900 $54.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1 1 2.142857 $25.7100 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 5 6 25.300000 $2057.4000 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 2.571429 $209.1100 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 2 2 3.366666 $273.7700 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 1 1 6.500000 $528.5800 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 8 8 45.785716 $3723.2800 $81.3200
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Subtotal (Total Children Is Unduplicated) 322 605 799.374203 $261964.1000 $327.7100
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Total 698 892.973409 $266067.1900 $297.9600
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Number of Children (Unduplicated) With at Least One Authorization 341