Summary Report for FSPSAs Initiated During the Report Period Statewide
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 13940 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 227 229 299.965867 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 4 6 19.590476 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 231 235 319.556343 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 94 107 66.396688 $3220.2400 $48.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 11 11 11.000000 $258.3900 $23.4900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.472222 $11.1900 $23.7000
EVAL -96111 DEVELOPMENTAL EVALUATION 27 36 37.510957 $1875.5500 $50.0000
EXIT -EXIT EXIT ASSESSMENT 385 402 589.577483 $29478.8900 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 0.544444 $40.8300 $74.9900
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 0.544444 $40.8300 $74.9900
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 3 3 1.583333 $118.7500 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 5 6 4.088889 $226.9300 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 7 7 12.005479 $900.4100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 4 4 8.000000 $600.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 16 16 26.291193 $1459.1600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 11 11 18.785714 $1408.9300 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 4.571429 $228.5700 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 0.172222 $8.7900 $51.0400
OCTH -97166 OT EVAL MODERATE COMPLEXITY 3 3 2.305556 $117.7000 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 15 15 5.427777 $277.0800 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 3 3 0.311111 $15.8800 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 1.202740 $61.4000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 15 15 11.333886 $578.5900 $51.0500
SCREEN-T1023 SCREENING 3 3 1.033334 $51.6700 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 31 32 14.145285 $722.1200 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.077778 $3.8100 $48.9500
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Subtotal (Total Children Is Unduplicated) 600 684 817.381964 $41705.7100 $51.0200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 9 12 15.816666 $79083.0000 $4999.9800
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.855556 $42.7800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 12 12 3.806012 $190.3000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 585 724 457.218676 $22861.1000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 30 32 24.384769 $609.6200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1635 1889 2782.141574 $139107.0400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 187 212 235.325111 $5883.1200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 637 776 1030.395454 $51519.7300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 72 125 116.322219 $2908.0500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 459 515 711.552385 $35577.6400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 29 49 47.705555 $1192.6400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1219 1274 1638.915806 $81945.6800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 174 185 198.983328 $4974.5700 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 2 2 3.633333 $266.3900 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 4 5 41.714286 $1042.8600 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 2 2 8.888889 $444.4500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 155 170 1154.968264 $57748.3900 $50.0000
INTR -T1013 INTERPRETER 175 197 728.064494 $36403.2400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3333 4431 24585.258180 $245852.5400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 57 57 389.326194 $27813.4600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 18 18 115.066669 $6581.8100 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 52 53 375.892861 $26853.7700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 6 7 32.785715 $1874.0300 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.200000 $13.0000 $65.0000
SENS -V5264 EARMOLD 1 1 0.002740 $0.0500 $17.7400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 99 102 718.845245 $51354.3000 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 7.857143 $109.0600 $13.8800
TRAV -TRAVS Travel by mile 1179 2168 186368.509873 $82933.9900 $0.4500
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Subtotal (Total Children Is Unduplicated) 5157 13021 221794.436997 $965186.5800 $4.3500
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Total 13940 222931.375304 $1006892.2900 $4.5200
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Number of Children (Unduplicated) With at Least One Authorization 5490