Summary Report for FSPSAs Ending During the Report Period Center: 02
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 1955 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 0.577169 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 3 3 0.577169 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 32 33 19.239400 $933.1200 $48.5000
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 0.488889 $24.4500 $50.0000
EXIT -EXIT EXIT ASSESSMENT 35 35 38.087519 $1904.3800 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 3 3 4.005479 $300.4100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 7 7 11.505479 $638.5600 $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
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 2 1.116667 $57.0100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.002740 $0.1400 $50.2900
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Subtotal (Total Children Is Unduplicated) 75 87 82.946173 $4471.6000 $53.9100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 5 10.193738 $50969.0000 $5000.0300
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 40 43 30.009629 $1500.4700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 0.005518 $0.1400 $24.9200
CONIF -CONIF CONSULT, ITDS FACE TO FACE 210 235 439.194583 $21959.7200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 4 6.302381 $157.5600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 81 82 109.176191 $5458.8200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.283333 $7.0800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 23 23 26.166667 $1308.3400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.166667 $4.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 156 161 295.285710 $14764.2700 $50.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 3.857143 $282.8000 $73.3200
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 4 4 20.071428 $1003.5700 $50.0000
INTR -T1013 INTERPRETER 19 27 56.823875 $2841.2000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 290 444 1720.638583 $17206.3700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 8 8 35.500001 $2536.1100 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 11 11 60.000001 $4286.4000 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4 4 20.428572 $1459.4100 $71.4400
TRAV -TRAVS Travel by mile 421 809 137366.921081 $61128.2800 $0.4500
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Subtotal (Total Children Is Unduplicated) 436 1865 140201.025101 $186873.7000 $1.3300
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Total 1955 140284.548443 $191345.3000 $1.3600
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Number of Children (Unduplicated) With at Least One Authorization 445