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: 01-01-18 and 03-31-18 Date of Report: 05-05-18 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1953 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 27 31 12.725952 $617.2100 $48.5000
EXIT -EXIT EXIT ASSESSMENT 47 48 71.355970 $3567.8000 $50.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 3 3 6.000000 $333.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 5 5 10.000000 $750.0000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.178082 $9.0900 $51.0600
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.323288 $16.5000 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.219178 $11.1900 $51.0600
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.161644 $8.2500 $51.0400
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 0.131507 $6.7100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 0.572755 $29.2400 $51.0500
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Subtotal (Total Children Is Unduplicated) 78 98 109.668376 $5870.9900 $53.5300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 2.517200 $12586.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 44 48 25.747393 $1287.3400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 1.255556 $31.3900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 209 246 429.755126 $21487.7800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 3 5.100000 $127.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 63 68 99.766667 $4988.3400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 4.450000 $111.2500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 24 25 40.700000 $2035.0000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 153 156 229.366674 $11468.3700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.383333 $34.5800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6 6 41.428570 $2071.4300 $50.0000
INTR -T1013 INTERPRETER 29 46 114.879060 $5743.9500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 274 453 1778.544178 $17785.4300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 4 38.142857 $2724.9200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 4 5 34.857143 $2490.1900 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 9 9 60.285713 $4306.8100 $71.4400
TRAV -TRAVS Travel by mile 319 776 131804.866088 $58653.1700 $0.4500
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Subtotal (Total Children Is Unduplicated) 331 1855 134713.045558 $147933.4400 $1.1000
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Total 1953 134822.713934 $153804.4300 $1.1400
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Number of Children (Unduplicated) With at Least One Authorization 348