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 1579 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 19 19 2.728465 $132.3300 $48.5000
EVAL -96111 DEVELOPMENTAL EVALUATION 6 7 0.616439 $30.8200 $49.9900
EXIT -EXIT EXIT ASSESSMENT 49 49 12.232649 $611.6300 $50.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.333333 $25.0000 $74.9900
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 8 8 0.060575 $4.5500 $75.1500
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 8 8 0.041093 $2.2900 $55.6300
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 0.005479 $0.4100 $75.2900
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 1 1 0.104110 $5.3100 $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 1 1 0.322222 $16.4500 $51.0500
SCREEN-T1023 SCREENING 2 3 0.628615 $31.4300 $50.0000
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.024658 $1.2400 $50.0900
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Subtotal (Total Children Is Unduplicated) 85 101 17.486679 $919.8000 $52.6000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 1.009210 $5046.5000 $5000.4500
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 145 282 427.274391 $21363.7500 $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 9 9 394.857142 $9871.4300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6 6 31.928570 $1596.4300 $50.0000
INTR -T1013 INTERPRETER 16 23 10.668593 $533.4400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 246 423 1514.993695 $15149.9300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 4 33.000000 $2357.5200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 5 6 34.928571 $2495.3000 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 9 9 83.142857 $5939.7200 $71.4400
TRAV -TRAVS Travel by mile 276 636 75038.371690 $33392.0900 $0.4500
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Subtotal (Total Children Is Unduplicated) 300 1477 77602.369837 $98971.5800 $1.2800
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Total 1579 77619.895405 $99891.3800 $1.2900
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Number of Children (Unduplicated) With at Least One Authorization 315