Summary Report for FSPSAs Ending During the Report Period Center: 01
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: 10-01-16 and 12-31-16 Date of Report: 02-04-17 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2959 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 43 44 156.957936 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 11.857143 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 43 45 168.815079 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 13 14 7.813622 $378.9600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.032877 $1.5500 $47.1200
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.188889 $4.8200 $25.5300
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 1.000000 $50.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 113 116 232.000000 $11600.0000 $50.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 0.002740 $0.1500 $54.6700
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 7 7 13.500000 $1012.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 3 3 5.500000 $412.5000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 7 7 14.000000 $777.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 2 3.000000 $225.0000 $75.0000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 2.181888 $111.3900 $51.0500
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Subtotal (Total Children Is Unduplicated) 141 159 284.220016 $14924.9200 $52.5100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.644444 $13222.0000 $4999.9200
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 10 10 19.116666 $955.8300 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 168 186 183.649900 $9182.4800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 4 4 3.883333 $97.0800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 82 117 221.030482 $11051.5100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 3 2.733334 $68.3400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 14 14 86.456348 $4322.8100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 22 23 75.482953 $3774.1500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 33 35 51.791271 $2589.5700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 9.428571 $235.7200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 15 15 65.076189 $3253.8000 $50.0000
INTR -T1013 INTERPRETER 68 73 295.935909 $14796.8000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 721 1051 4787.892625 $47878.9100 $10.0000
PHY -97110 PT SESSION BY LICENSED PT 2 2 4.571428 $326.5800 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 15 17 105.600001 $7544.0600 $71.4400
TRAV -TRAVS Travel by mile 832 1202 14156.519950 $6299.6500 $0.4500
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Subtotal (Total Children Is Unduplicated) 855 2755 20071.813404 $125599.2600 $6.2600
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Total 2959 20524.848499 $140524.1800 $6.8500
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Number of Children (Unduplicated) With at Least One Authorization 898