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: 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 603 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 2 2 1.033333 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 2 1.033333 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 2 3 0.355555 $17.2400 $48.4900
EXIT -EXIT EXIT ASSESSMENT 5 5 3.983333 $199.1700 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 0.611111 $45.8300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 5 5 1.222221 $91.6600 $74.9900
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 0.327778 $24.5900 $75.0100
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 6 6 1.372221 $76.1500 $55.5000
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Subtotal (Total Children Is Unduplicated) 14 23 7.872219 $454.6300 $57.7500
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.422222 $21.1100 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 20 20 12.983333 $649.1700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 1.150000 $28.7500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 76 104 126.069046 $6303.4400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 4 2.177777 $54.4400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2 2 0.355555 $17.7800 $49.9900
CONPF -CONPF CONSULT, PT, FACE TO FACE 3 3 4.333334 $216.6700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.333333 $8.3300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 3 3 3.000000 $150.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 295 438 1565.544440 $15655.4400 $10.0000
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Subtotal (Total Children Is Unduplicated) 299 578 1716.369040 $23105.1300 $13.4600
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Total 603 1725.274592 $23559.7600 $13.6600
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Number of Children (Unduplicated) With at Least One Authorization 301