Summary Report for FSPSAs Ending During the Report Period Center: 02
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: 10-01-19 and 12-31-19 Date of Report: 02-01-20 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2317 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
CASE -CASE NON-TCM CASE MANAGEMENT 1 1 0.811111 $30.0100 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 3 3 1.939682 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 4 4 2.750793 $30.0100 $10.9100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 20 21 9.642085 $467.6400 $48.5000
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 1 1 3.285714 $160.2100 $48.7600
EXIT -EXIT EXIT ASSESSMENT 58 58 63.797259 $3189.8700 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 5 5 9.000000 $675.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 2 2 2.005479 $150.4100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 8 8 13.005479 $721.8100 $55.5000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 0.326027 $16.6400 $51.0500
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Subtotal (Total Children Is Unduplicated) 86 97 101.062043 $5381.5700 $53.2500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.261111 $1305.5000 $4999.7900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 55 59 55.055005 $2752.7300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 2.700000 $67.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 242 269 452.569406 $22628.4700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 5 5 9.933333 $248.3300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 124 129 198.809525 $9940.4800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 4.333333 $108.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 19 19 23.133332 $1156.6600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 205 212 317.890477 $15894.5300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 10.466667 $261.6700 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 3.285714 $240.9100 $73.3200
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 9 11 56.785714 $2839.2800 $50.0000
INTR -T1013 INTERPRETER 24 42 63.758806 $3187.9400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 305 521 1937.498174 $19374.9900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 3.928571 $280.6600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 2 2 1.571429 $112.2600 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 3 17.953033 $1282.5600 $71.4400
TRAV -TRAVS Travel by mile 419 932 144532.846600 $64317.1200 $0.4500
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Subtotal (Total Children Is Unduplicated) 441 2216 147692.780230 $145999.9000 $0.9900
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Total 2317 147796.593066 $151411.4900 $1.0200
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Number of Children (Unduplicated) With at Least One Authorization 449