Summary Report for FSPSAs Initiated During the Report Period Center: 06
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: 02-06-19 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1520 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 42 42 81.273015 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 42 42 81.273015 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 1.000000 $48.5000 $48.5000
EXIT -EXIT EXIT ASSESSMENT 25 25 50.000000 $2500.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 26 26 51.000000 $2548.5000 $49.9700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 4 4 2.844444 $142.2200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 11 11 11.488891 $574.4600 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 102 105 24.533598 $1226.8200 $50.0100
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 6 6 1.535319 $38.3900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 11 13 9.355556 $467.7800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 5 5 4.316666 $107.9200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 7 8 10.483333 $524.1700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 1.100000 $27.5000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 3 3 4.933334 $246.6700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.483333 $37.0800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 10 11 8.857143 $442.8600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 1.833333 $45.8300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 32 32 828.285712 $20707.1400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 422 460 3028.042902 $151402.1500 $50.0000
INTR -T1013 INTERPRETER 15 15 75.942857 $3797.1500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 492 585 3734.352439 $37343.5300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 43 47 202.300001 $14452.3200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 6 7 20.471429 $1170.9600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 37 43 172.749999 $12341.2500 $71.4400
SENS -V5060 BEHIND EAR HEARING AID 1 1 0.466667 $106.4100 $228.0200
SENS -V5264 EARMOLD 12 12 8.188890 $147.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 64 76 302.109524 $21582.6700 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 1.857143 $25.7800 $13.8800
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Subtotal (Total Children Is Unduplicated) 557 1452 8458.532513 $271958.4200 $32.1500
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Total 1520 8590.805528 $274506.9200 $31.9500
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Number of Children (Unduplicated) With at Least One Authorization 604