Summary Report for FSPSAs Ending During the Report Period Center: 01
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: 10-01-18 and 12-31-18 Date of Report: 02-05-19 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 3366 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 68 70 100.036510 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 68 70 100.036510 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 10 10 4.966591 $240.8900 $48.5000
EXIT -EXIT EXIT ASSESSMENT 157 161 319.500000 $15975.0000 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 5 5 8.500000 $471.7500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 4 4 7.500000 $562.5000 $75.0000
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 173 183 345.466591 $17601.1900 $50.9500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 9.038889 $45194.5000 $5000.0100
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 9 9 5.516667 $275.8400 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.044444 $10.2100 $229.7700
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 174 187 188.131272 $9406.5800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 4 4.000000 $100.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 82 92 167.814288 $8390.7300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 19 20 39.021429 $1951.0700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 2.533333 $63.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 39 39 52.017462 $2600.8800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 57 62 83.107919 $4155.4200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 2.466667 $61.6700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 41 42 225.542857 $11277.1400 $50.0000
INTR -T1013 INTERPRETER 119 124 308.215719 $15410.8000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 778 1137 5163.504382 $51635.0400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 5 7 39.857144 $2847.3900 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 3 3 5.852380 $418.0900 $71.4400
RSPT -RSPT RESPITE 1 1 3.571429 $0.0000 $0.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 20 20 133.971427 $9570.9200 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 7.571429 $105.0900 $13.8800
TRAV -TRAVS Travel by mile 947 1359 5471.202001 $2434.6900 $0.4500
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Subtotal (Total Children Is Unduplicated) 998 3113 11912.981138 $165909.3700 $13.9300
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Total 3366 12358.484239 $183510.5500 $14.8500
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Number of Children (Unduplicated) With at Least One Authorization 1044