Summary Report for FSPSAs Ending During the Report Period Center: 02
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 1472 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
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 24 26 13.219474 $641.1500 $48.5000
EVAL -96111 DEVELOPMENTAL EVALUATION 4 4 2.339725 $116.9900 $50.0000
EXIT -EXIT EXIT ASSESSMENT 43 44 25.464231 $1273.2300 $50.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 1.000000 $55.5000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 4 4 2.016437 $151.2400 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 7 7 8.016437 $444.9200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 1 3 0.011036 $0.5600 $50.8800
PSTH -97001 EVAL BY LICENSED PT, INITIAL 3 3 0.200000 $10.2100 $51.0500
SCREEN-T1023 SCREENING 5 5 1.649696 $82.4900 $50.0000
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Subtotal (Total Children Is Unduplicated) 81 98 55.917036 $2926.2700 $52.3300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 0.298630 $1493.5000 $5001.1700
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 41 43 10.958643 $547.9200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 6 9.768055 $244.2000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 135 167 293.165797 $14658.2900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 6 8 14.566665 $364.1600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 27 30 42.283330 $2114.1500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 18 18 30.399998 $1519.9900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.166667 $29.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 93 96 168.093654 $8404.7000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.900000 $47.5000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 44.285714 $1107.1400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 7 7 22.547619 $1127.3800 $50.0000
INTR -T1013 INTERPRETER 10 15 25.214807 $1260.7500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 229 361 1344.125764 $13441.2300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 6 6 52.928572 $3781.2100 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 10 10 84.028573 $6003.0000 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 14 14 81.571428 $5827.4500 $71.4400
TRAV -TRAVS Travel by mile 327 588 78794.522418 $35063.5700 $0.4500
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Subtotal (Total Children Is Unduplicated) 345 1374 81021.826334 $97035.3000 $1.2000
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Total 1472 81077.743370 $99961.5700 $1.2300
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Number of Children (Unduplicated) With at Least One Authorization 358