Summary Report for FSPSAs Initiated During the Report Period Center: 01
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: 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 3113 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 44 44 61.552377 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 44 44 61.552377 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 18 20 13.763395 $667.5300 $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
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Subtotal (Total Children Is Unduplicated) 181 192 353.263395 $17976.7800 $50.8900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 4 11.000000 $55000.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.855556 $42.7800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 5 5 2.205556 $110.2800 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 174 187 182.060333 $9103.0300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 6 9.233333 $230.8300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 66 75 154.707145 $7735.3700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 1.600000 $40.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 16 17 29.677780 $1483.9000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 36 37 66.038889 $3301.9500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 48 51 80.434924 $4021.7600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 4 3.200000 $80.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 9 9 76.571430 $3828.5700 $50.0000
INTR -T1013 INTERPRETER 114 124 354.458580 $17722.9400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 789 1060 5750.899670 $57508.9900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 15.714286 $1122.6300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1 1 6.714286 $479.6700 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 7 7 77.285716 $5521.2800 $71.4400
TRAV -TRAVS Travel by mile 842 1285 6116.863952 $2722.0100 $0.4500
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Subtotal (Total Children Is Unduplicated) 867 2877 12939.521436 $170055.9800 $13.1400
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Total 3113 13354.337208 $188032.7500 $14.0800
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Number of Children (Unduplicated) With at Least One Authorization 883