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: 07-01-19 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 625 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 2 2 0.733333 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 4.000000 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 2 2 3.911111 $144.7100 $37.0000
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Subtotal (Total Children Is Unduplicated) 5 5 8.644444 $144.7100 $16.7400
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 0.488889 $23.7100 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.088889 $2.1100 $23.7000
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Subtotal (Total Children Is Unduplicated) 2 2 0.577778 $25.8200 $44.6900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.088889 $4.4500 $50.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 19 23 23.155556 $1157.7800 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 19 20 29.438889 $1471.9500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 24 25 32.877778 $1643.8900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 32 34 66.342064 $3317.1100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 11 11 12.927777 $646.3900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 4.888889 $122.2200 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 1.000000 $25.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 5 6 19.142857 $957.1500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 356 491 1937.695240 $19376.9600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 0.600000 $42.8600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1 2 8.266667 $590.5700 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.377778 $24.5600 $65.0000
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Subtotal (Total Children Is Unduplicated) 361 618 2137.802384 $34380.8700 $16.0800
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Total 625 2147.024606 $34551.4000 $16.0900
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Number of Children (Unduplicated) With at Least One Authorization 364