Summary Report for FSPSAs Ending During the Report Period Center: 01
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: 07-01-19 and 09-30-19 Date of Report: 11-04-19 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 3789 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 43 44 148.486505 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 11 11 305.714287 $11311.4300 $37.0000
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Subtotal (Total Children Is Unduplicated) 53 55 454.200792 $11311.4300 $24.9000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 15 16 10.002130 $485.1000 $48.5000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 1.000000 $84.8400 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 3 3 0.705556 $36.0400 $51.0700
EXIT -EXIT EXIT ASSESSMENT 206 209 410.750000 $20537.5000 $50.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 2 0.907143 $50.3400 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 11 11 19.500000 $1082.2500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 8 9 15.000000 $1125.0000 $75.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 2.000000 $102.1000 $51.0500
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Subtotal (Total Children Is Unduplicated) 235 255 464.864829 $23854.2200 $51.3100
EI Services, Class # 03
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.911111 $45.5600 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 9.428571 $471.4300 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 230 252 293.717930 $14685.9000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 6 6 5.000000 $125.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 83 92 189.900007 $9495.0400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 5 5 3.816667 $95.4200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 24 25 57.560318 $2878.0200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 45 46 69.788890 $3489.4500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 1.566667 $39.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 55 57 83.655555 $4182.7800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 2.133334 $53.3400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 30 33 192.623809 $9631.2000 $50.0000
INTR -T1013 INTERPRETER 106 118 313.573158 $15678.6700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 831 1287 6099.766764 $60997.6700 $10.0000
PHY -97110 PT SESSION BY LICENSED PT 4 7 13.619047 $972.9400 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 5 6 29.285714 $2092.1700 $71.4400
TRAV -TRAVS Travel by mile 957 1538 6421.659981 $2857.6400 $0.4400
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Subtotal (Total Children Is Unduplicated) 1002 3479 13788.007523 $127791.3600 $9.2700
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Total 3789 14707.073144 $162957.0100 $11.0800
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Number of Children (Unduplicated) With at Least One Authorization 1027