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: 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 643 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
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 10.285714 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 3 3 11.319047 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.494444 $10.6500 $21.5500
EXIT -EXIT EXIT ASSESSMENT 5 5 3.272222 $163.6100 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 0.961111 $72.0800 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 4 4 13.425397 $1006.9100 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.588889 $44.1700 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 5 5 1.977778 $148.3400 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 5 5 2.138889 $118.7100 $55.5000
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Subtotal (Total Children Is Unduplicated) 14 24 22.858730 $1564.4600 $68.4400
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.733333 $86.6700 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 19 19 12.838889 $641.9500 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 74 100 108.061108 $5403.0400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.411111 $10.2800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3 3 0.672223 $33.6200 $50.0100
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 0.116667 $5.8400 $50.0100
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4 4 2.977778 $148.8900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6 6 23.000001 $1150.0000 $50.0000
INTR -T1013 INTERPRETER 1 1 8.266667 $413.3400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 346 479 1786.872234 $17868.7100 $10.0000
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Subtotal (Total Children Is Unduplicated) 348 616 1944.950011 $25762.3200 $13.2500
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Total 643 1979.127788 $27326.7800 $13.8100
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Number of Children (Unduplicated) With at Least One Authorization 352