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 06-30-18 Date of Report: 08-10-18 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 3050 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 3 3 1.544444 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 6 7 48.385714 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 9 10 49.930158 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 4 5 5.755557 $279.1500 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 1.116667 $24.0600 $21.5500
EXIT -EXIT EXIT ASSESSMENT 14 14 14.477777 $723.8900 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 2 1.033333 $77.5000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 23 23 12.550001 $941.2600 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 44 45 23.894448 $1792.1100 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 3 3 1.911111 $143.3300 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 22 22 13.911114 $1043.3600 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 56 58 37.300004 $2070.1700 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 0.627778 $47.0900 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 3.000000 $166.5000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
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Subtotal (Total Children Is Unduplicated) 93 178 117.577790 $7458.4100 $63.4300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 1.116667 $5583.5000 $5000.1500
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 3 3.611111 $180.5600 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.811111 $186.5500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 104 119 181.773015 $9088.6600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 10 10 7.655556 $191.3900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 311 524 1135.220861 $56761.1000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 15 16 33.395238 $834.8800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 9 9 15.394444 $769.7200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 12 12 28.055556 $1402.7800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 2 6.466667 $161.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 7 7 16.094445 $804.7300 $50.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 4 5 22.450793 $1646.0900 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 2 2 12.844444 $321.1100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 33 38 171.840475 $8592.0300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 928 2110 17911.782756 $179117.8200 $10.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 2 1.900000 $123.5000 $65.0000
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Subtotal (Total Children Is Unduplicated) 929 2862 19550.413139 $265766.0800 $13.5900
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Total 3050 19717.921087 $273224.5000 $13.8600
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Number of Children (Unduplicated) With at Least One Authorization 936