Summary Report for FSPSAs Initiated During the Report Period Center: 03
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: 10-01-24 and 12-31-24 Date of Report: 03-31-25 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 585 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 35 35 26.320635 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 35 35 26.320635 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 3 4 4.000000 $194.0000 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 4 3.350000 $106.5600 $31.8100
OCTH -97167 OT EVAL HIGH COMPLEXITY 20 22 9.883334 $574.3200 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.177778 $10.3300 $58.1200
PSTH -97163 PT EVAL HIGH COMPLEXITY 21 21 12.022222 $698.6100 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.127778 $7.4300 $58.1200
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 21 22 13.172221 $765.4300 $58.1100
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Subtotal (Total Children Is Unduplicated) 64 75 42.733333 $2356.6900 $55.1500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 5 4.350000 $21750.0000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5 5 7.744445 $387.2300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 30 33 36.600001 $1830.0100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 14 15 18.422221 $921.1100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 33 35 48.288887 $2414.4400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 203 283 1198.485713 $64718.2300 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 2 11.857143 $640.2900 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 24 31 142.990476 $11627.9900 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 25 31 156.456348 $12723.0300 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 28 35 133.785713 $10879.4500 $81.3200
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Subtotal (Total Children Is Unduplicated) 280 475 1758.980947 $127891.7600 $72.7100
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Total 585 1828.034915 $130248.4500 $71.2500
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Number of Children (Unduplicated) With at Least One Authorization 316