Summary Report for FSPSAs Ending During the Report Period Center: 53
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: 04-01-16 and 06-30-16 Date of Report: 08-06-16 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1342 FSPSA's found of which 2 had no frequency modifier field, FORCE FREQ MODIFIER to 0
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
SCTT -SCTT SERVICE COORDINATOR TRAVEL 5 8 19.007938 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 8 19.007938 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 2 2.622222 $127.1800 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 6 6 1.744445 $38.2900 $21.9500
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 0.366667 $23.8900 $65.1500
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 0.005556 $0.2100 $38.6800
EXIT -EXIT EXIT ASSESSMENT 6 6 8.333333 $416.6700 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 3 2.783333 $208.7500 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 7 7 7.972223 $597.9200 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 20 26 20.844447 $1563.3500 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 1.166667 $87.5000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 12 12 12.383334 $928.7600 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 42 52 41.008734 $2276.0000 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 35 35 70.000000 $3885.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 8 8 12.022222 $901.6700 $75.0000
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 1 1 1.533333 $78.2800 $51.0500
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Subtotal (Total Children Is Unduplicated) 100 161 182.786516 $11133.4600 $60.9100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 1.611111 $8055.5000 $4999.9700
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 28 28 9.911807 $495.6000 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.433333 $31.0300 $71.6000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.093151 $22.2900 $239.3300
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 45 57 64.893324 $3244.6700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 3 1.838889 $45.9700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 116 156 202.207144 $10110.3700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 14 21 21.744443 $543.6100 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 8.857143 $649.4000 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 5 5 18.923809 $473.0900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 314 380 1964.549208 $98227.4800 $50.0000
INTR -T1013 INTERPRETER 1 1 6.857143 $342.8600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 351 514 2022.829370 $20228.3000 $10.0000
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Subtotal (Total Children Is Unduplicated) 374 1172 4324.749875 $142470.1500 $32.9400
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Total 1341 4526.544329 $153603.6100 $33.9300
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Number of Children (Unduplicated) With at Least One Authorization 382