Summary Report for FSPSAs Initiated During the Report Period Center: 53
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: 10-01-17 and 12-31-17 Date of Report: 02-03-18 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 630 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 0.511111 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 3.933333 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 2 4.444444 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 2 2 2.266667 $113.3400 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 0.394445 $29.5900 $75.0100
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 5 5 2.638888 $197.9100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 3 3 0.955555 $71.6600 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 8 9 3.911110 $217.0600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 0.027778 $2.0900 $75.0600
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Subtotal (Total Children Is Unduplicated) 11 22 10.194443 $631.6400 $61.9600
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 27 29 22.714285 $1135.7200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 6 6 3.505556 $87.6400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 75 93 111.411113 $5570.5700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 3 1.561111 $39.0300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1 1 0.083333 $4.1700 $49.9800
CONPF -CONPF CONSULT, PT, FACE TO FACE 1 1 1.500000 $75.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 12 12 28.776192 $1438.8100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 337 460 1885.976204 $18859.7400 $10.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.133333 $8.6600 $64.9800
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Subtotal (Total Children Is Unduplicated) 346 606 2055.661127 $27219.3300 $13.2400
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Total 630 2070.300014 $27850.9700 $13.4500
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Number of Children (Unduplicated) With at Least One Authorization 347