Summary Report for FSPSAs Initiated During the Report Period Center: 53
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 887 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
CASE -CASE NON-TCM CASE MANAGEMENT 1 1 0.142857 $5.2900 $37.0100
SCTT -SCTT SERVICE COORDINATOR TRAVEL 5 6 13.565477 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 5 7 13.708334 $5.2900 $0.3900
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 3 1.433333 $69.5200 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.266667 $2.7800 $10.4200
EXIT -EXIT EXIT ASSESSMENT 4 4 25.911111 $1295.5600 $50.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 9 9 0.644447 $48.3500 $75.0300
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 9 9 0.644447 $35.7800 $55.5200
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 15 26 28.900005 $1451.9800 $50.2400
EI Services, Class # 03
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 0.505556 $25.2800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 44 44 14.438726 $721.9500 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 41 43 109.588888 $5479.4400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 4 0.505556 $12.6400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 146 185 229.034921 $11451.7500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 14 18 19.088888 $477.2200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 10 13 35.204761 $1760.2500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 363 543 2012.825508 $20128.2800 $10.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.200000 $13.0000 $65.0000
TRAV -TRAVS Travel by mile 1 1 0.005556 $0.0000 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 378 854 2421.398360 $40069.8100 $16.5500
-------------------------------------------------------------------------------------------------------------------------------------
Total 887 2464.006699 $41527.0800 $16.8500
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 382