Summary Report for FSPSAs Initiated During the Report Period Center: 04
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: 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 860 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 27 28 14.603175 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 27 28 14.603175 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 2 0.377778 $18.3200 $48.5000
OCTH -97167 OT EVAL HIGH COMPLEXITY 2 2 0.161111 $8.2200 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 3 3 0.850000 $43.3900 $51.0500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 6 7 1.388889 $69.9400 $50.3600
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 24 60 14.027774 $701.3700 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1 1 0.155556 $7.7800 $50.0100
CONOF -CONOF CONSULT, OT, FACE TO FACE 1 1 0.222222 $11.1100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 3 3 0.611111 $30.5600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.366667 $34.1700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 8.571429 $214.2900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 14 17 99.571430 $4978.5700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 628 736 5143.368312 $51433.6800 $10.0000
OCCT -97530HM OT SESSION BY OT ASST 2 2 4.142857 $236.9700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1 1 10.571429 $755.2200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 5.285715 $302.1300 $57.1600
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 655 825 5287.894502 $58705.8400 $11.1000
-------------------------------------------------------------------------------------------------------------------------------------
Total 860 5303.886566 $58775.7800 $11.0800
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 682