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: 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 241 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 30 30 18.209523 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 30 30 18.209523 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 4 4 4.000000 $194.0000 $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 3 4 1.044444 $53.6900 $51.4100
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Subtotal (Total Children Is Unduplicated) 7 9 5.172222 $254.2600 $49.1600
EI Services, Class # 03
CONIF -CONIF CONSULT, ITDS FACE TO FACE 11 11 14.522223 $726.1200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 72 89 91.777781 $4588.9100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 26 33 36.144445 $1807.2300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 42 51 51.555559 $2577.8000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 9 12 49.933335 $2496.6700 $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 9.142857 $657.9200 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4 4 16.225396 $1167.5800 $71.9600
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Subtotal (Total Children Is Unduplicated) 146 202 272.587310 $14258.6500 $52.3100
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Total 241 295.969055 $14512.9100 $49.0400
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Number of Children (Unduplicated) With at Least One Authorization 178