Summary Report for FSPSAs Initiated During the Report Period Center: 02
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: 01-01-16 and 03-31-16 Date of Report: 05-12-16 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2265 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 1 1 0.038889 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 0.038889 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 25 25 3.830596 $185.7900 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 0.210959 $4.6300 $21.9400
EVAL -96111 DEVELOPMENTAL EVALUATION 7 8 0.906850 $45.3400 $49.9900
EXIT -EXIT EXIT ASSESSMENT 49 49 12.232649 $611.6300 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 5 5 0.027395 $2.0600 $75.2900
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 0.005479 $0.4100 $75.2900
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 0.511111 $38.3300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 7 7 0.043985 $2.4500 $55.6400
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 113 113 0.728503 $54.7600 $75.1600
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 13 13 0.208214 $15.6400 $75.1000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 135 135 2.251857 $125.0800 $55.5500
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 14 14 0.071228 $5.3600 $75.1800
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 4 4 0.846967 $43.2400 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 7 7 2.393152 $122.1700 $51.0500
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 2 2 0.389041 $58.3500 $149.9800
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 5 5 0.921310 $47.0300 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 13 13 2.471842 $126.1900 $51.0500
SCREEN-T1023 SCREENING 2 3 0.628615 $31.4300 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 12 12 1.714307 $87.5100 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 2 2 0.169863 $8.5000 $50.0100
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Subtotal (Total Children Is Unduplicated) 227 422 30.563923 $1615.8800 $52.8700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 28 28 4.606929 $23036.0000 $5000.2900
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.041096 $2.0600 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 47 55 10.134617 $506.6900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 3 4.269406 $106.7300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 145 283 428.941058 $21447.0900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 4 8.866666 $221.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1 1 0.050000 $2.5000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 10 10 6.600000 $330.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 2.233333 $55.8300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 23 24 829.285711 $20732.1500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 177 187 1298.990464 $64949.5500 $50.0000
INTR -T1013 INTERPRETER 16 23 10.668593 $533.4400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 246 424 1520.922266 $15209.2100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 38 40 338.357145 $24172.2300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 53 58 372.683947 $26624.5900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 0.156164 $8.9300 $57.1700
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 57 61 443.406258 $31676.9700 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 4.285714 $245.1400 $57.2000
TRAV -TRAVS Travel by mile 276 637 75394.085976 $33550.3800 $0.4500
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Subtotal (Total Children Is Unduplicated) 313 1842 80678.585343 $263411.1500 $3.2600
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Total 2265 80709.188155 $265027.0300 $3.2800
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Number of Children (Unduplicated) With at Least One Authorization 326