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 229 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
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.127778 $6.5700 $51.4200
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 0.916666 $47.1200 $51.4100
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Subtotal (Total Children Is Unduplicated) 8 9 6.150000 $301.3100 $48.9900
EI Services, Class # 03
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 11 13 39.571428 $1978.5800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 3.285714 $236.4400 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 1 1 3.714286 $267.2800 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 3 6.584126 $473.7900 $71.9600
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Subtotal (Total Children Is Unduplicated) 136 171 215.449208 $11070.7800 $51.3800
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Total 229 244.354763 $11372.1000 $46.5400
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Number of Children (Unduplicated) With at Least One Authorization 188