Summary Report for FSPSAs Ending During the Report Period Center: 53
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: 07-01-18 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 2849 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 4 4 5.144444 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 6 8 67.823810 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 2 2 5.227778 $193.4300 $37.0000
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Subtotal (Total Children Is Unduplicated) 12 14 78.196032 $193.4300 $2.4700
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 11 12 11.755556 $570.1500 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.866667 $20.5400 $23.7000
EXIT -EXIT EXIT ASSESSMENT 6 6 46.866667 $2343.3400 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 18 18 14.811110 $1110.8300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 31 31 25.091268 $1881.8300 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 15 15 11.855554 $889.1600 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 26 26 23.461110 $1302.0900 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 2.650000 $198.7500 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.000000 $50.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 68 113 140.357932 $8477.6700 $60.4000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 3.000000 $15000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.833333 $41.6700 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 2 3 2.505555 $576.2700 $229.9900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 60 72 47.784921 $2389.2500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.000000 $25.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 203 293 647.961108 $32398.0400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 4 3.233333 $80.8300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 61 69 116.294444 $5814.7200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 58 69 198.748410 $9937.4100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 51 60 122.322223 $6116.1200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 2.644444 $66.1100 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 5 8 17.633333 $1292.8700 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 6 7 30.317459 $757.9400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 46 54 485.988889 $24299.4500 $50.0000
INTR -T1013 INTERPRETER 3 5 34.666667 $1733.3400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 950 2066 18508.653923 $185086.5400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 11.142857 $796.0500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 19.857143 $1135.8300 $57.2000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 2 1.716666 $111.5800 $65.0000
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Subtotal (Total Children Is Unduplicated) 953 2722 20256.304708 $287658.9900 $14.2000
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Total 2849 20474.858672 $296330.0900 $14.4700
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Number of Children (Unduplicated) With at Least One Authorization 959