Summary Report for FSPSAs Initiated During the Report Period Center: 02
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: 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 1428 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 1 1 1.766667 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 1.766667 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 18 20 2.732346 $132.5200 $48.5000
EXIT -EXIT EXIT ASSESSMENT 44 44 19.387671 $969.3900 $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
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1 1 0.333333 $17.0200 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 1 3 0.011036 $0.5600 $50.8800
SCREEN-T1023 SCREENING 2 2 0.444444 $22.2200 $50.0000
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Subtotal (Total Children Is Unduplicated) 71 83 35.941704 $1943.3600 $54.0700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.123288 $616.5000 $5000.4900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 39 44 11.540376 $577.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 4 5 4.629166 $115.7300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 133 157 266.794367 $13339.7200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 4 7.090476 $177.2600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 30 33 52.816666 $2640.8300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 2.666666 $66.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 20 20 38.866668 $1943.3400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 2.200000 $55.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 101 103 181.693649 $9084.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 3 6.733334 $168.3400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 12 12 80.947618 $4047.3800 $50.0000
INTR -T1013 INTERPRETER 9 14 57.964905 $2898.2500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 204 338 1425.060529 $14250.5800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 4 26.142857 $1867.6500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 6 6 37.857142 $2704.5200 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 8 8 67.428571 $4817.0900 $71.4400
TRAV -TRAVS Travel by mile 260 589 90682.553274 $40353.7400 $0.4500
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Subtotal (Total Children Is Unduplicated) 275 1344 92953.109552 $99724.2500 $1.0700
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Total 1428 92990.817923 $101667.6100 $1.0900
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Number of Children (Unduplicated) With at Least One Authorization 298