Summary Report for FSPSAs Initiated During the Report Period Center: 53
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: 04-01-19 and 06-30-19 Date of Report: 07-21-19 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 596 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 5 5 4.419047 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 2.266667 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 2.000000 $74.0000 $37.0000
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Subtotal (Total Children Is Unduplicated) 7 7 8.685714 $74.0000 $8.5200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 3 3 2.227778 $108.0500 $48.5000
EXIT -EXIT EXIT ASSESSMENT 1 1 1.000000 $50.0000 $50.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 0.416667 $31.2500 $75.0100
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 0.416667 $23.1300 $55.5000
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Subtotal (Total Children Is Unduplicated) 5 6 4.061112 $212.4300 $52.3100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 16 17 9.046825 $452.3400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 21 23 34.826985 $1741.3500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 15 16 29.988889 $1499.4500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 24 26 31.805556 $1590.2800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 11 12 15.977778 $798.8900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 3.277778 $81.9500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 7 8 26.695239 $1334.7600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 362 477 1985.458748 $19854.5700 $10.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.311111 $20.2200 $65.0000
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Subtotal (Total Children Is Unduplicated) 366 583 2138.388909 $32373.8000 $15.1400
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Total 596 2151.135735 $32660.2300 $15.1800
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Number of Children (Unduplicated) With at Least One Authorization 369