Summary Report for FSPSAs Initiated During the Report Period Center: 54
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 1437 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 3 3 7.123810 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 5.333333 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 4 4 12.457143 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 30 35 27.022223 $1310.5800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.472222 $26.6700 $56.4900
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 0.166667 $14.1400 $84.8600
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.000000 $45.0000 $45.0000
EXIT -EXIT EXIT ASSESSMENT 48 49 84.655969 $4232.8100 $50.0000
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.505556 $25.2800 $50.0000
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Subtotal (Total Children Is Unduplicated) 80 88 113.822637 $5654.4800 $49.6800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 12 16 22.305556 $111528.0000 $5000.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 95 100 86.354120 $4317.7100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 1.005556 $25.1400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 60 67 82.560314 $4128.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 78 82 67.694442 $3384.7100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.200000 $5.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 63 69 55.405553 $2770.2700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 118 119 85.456348 $4272.8200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 3.061111 $76.5300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 23 24 116.663494 $5833.1700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 470 855 2949.840488 $29498.3900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 34.000000 $2428.9600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1 2 11.955555 $854.1000 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 2 12.928571 $923.6200 $71.4400
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Subtotal (Total Children Is Unduplicated) 473 1345 3529.431108 $170046.4000 $48.1800
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Total 1437 3655.710888 $175700.8800 $48.0600
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Number of Children (Unduplicated) With at Least One Authorization 491