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: 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 670 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 0.422222 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 2.733333 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 3 3 3.155555 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 2 2 0.200608 $9.7300 $48.5000
EXIT -EXIT EXIT ASSESSMENT 1 1 0.750000 $37.5000 $50.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 3 4.299999 $215.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 6 6 5.250607 $262.2200 $49.9400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 19 23 23.061111 $1153.0600 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 19 20 18.160318 $908.0200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 36 37 39.983334 $1999.1700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.857143 $21.4300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 36 37 42.744446 $2137.2300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 11 11 15.884921 $794.2500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 2.666667 $66.6700 $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 6 6 28.819047 $1440.9600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 363 521 1724.840657 $17248.4000 $10.0000
PHY -97110 PT SESSION BY LICENSED PT 1 1 5.000000 $357.2000 $71.4400
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Subtotal (Total Children Is Unduplicated) 366 661 1904.017644 $31151.3700 $16.3600
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Total 670 1912.423806 $31413.5900 $16.4300
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Number of Children (Unduplicated) With at Least One Authorization 369