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 818 FSPSA's found of which 1 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
EXIT -EXIT EXIT ASSESSMENT 6 6 8.333333 $416.6700 $50.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 3 3 0.683334 $51.2600 $75.0100
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 5 5 0.694446 $38.5500 $55.5100
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) 13 17 13.866668 $711.9200 $51.3400
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 28 28 9.911807 $495.6000 $50.0000
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
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 12 12 25.505555 $1275.2900 $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) 363 792 2355.787675 $36286.6500 $15.4000
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Total 817 2388.662281 $36998.5700 $15.4900
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Number of Children (Unduplicated) With at Least One Authorization 365