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: 07-01-17 and 09-30-17 Date of Report: 11-04-17 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 915 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
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 3 3.533333 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 3 3.533333 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.216667 $4.6700 $21.5500
EXIT -EXIT EXIT ASSESSMENT 5 5 4.594444 $229.7200 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 12 12 3.994445 $299.5900 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 21 21 6.633337 $497.5300 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.483333 $36.2500 $74.9900
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 12 12 4.194446 $314.6000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 24 24 8.444447 $468.6800 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 1.000000 $55.5000 $55.5000
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Subtotal (Total Children Is Unduplicated) 42 77 29.561119 $1906.5300 $64.4900
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.144444 $7.2200 $49.9800
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 37 42 89.878571 $4493.9300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 2.000000 $50.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 136 183 188.482643 $9424.1600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 6 6 2.550001 $63.7500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 0.544444 $27.2200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.300000 $7.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2 2 5.066667 $253.3400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 9 9 24.635713 $1231.7900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 370 587 2261.477079 $22614.7600 $10.0000
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Subtotal (Total Children Is Unduplicated) 380 835 2575.079562 $38173.6700 $14.8200
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Total 915 2608.174014 $40080.2000 $15.3700
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Number of Children (Unduplicated) With at Least One Authorization 381