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: 01-01-23 and 03-31-23 Date of Report: 04-20-23 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 786 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 48 49 22.755555 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 48 49 22.755555 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 6 6 5.105556 $247.6200 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.000000 $28.9200 $28.9200
OCTH -97165 OT EVAL LOW COMPLEXITY 19 23 11.561111 $594.3600 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 11 11 5.472221 $281.3200 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 14 15 6.022221 $309.6000 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 6.571429 $337.8400 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 40 47 20.872220 $1073.0300 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.183333 $8.2200 $44.8500
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Subtotal (Total Children Is Unduplicated) 85 105 56.788091 $2880.9000 $50.7300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 5 4.105556 $20528.0000 $5000.0500
CONIF -CONIF CONSULT, ITDS FACE TO FACE 7 7 6.666668 $333.3400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 55 60 65.177778 $3258.8900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 23 29 27.133333 $1356.6700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 51 57 63.315875 $3165.8000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 304 355 1273.734921 $63686.7600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 23 28 89.293650 $6425.5700 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 35 36 142.833335 $10278.2800 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 44 55 180.207938 $12967.7600 $71.9600
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Subtotal (Total Children Is Unduplicated) 415 632 1852.469054 $122001.0500 $65.8600
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Total 786 1932.012700 $124881.9600 $64.6400
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Number of Children (Unduplicated) With at Least One Authorization 463