Summary Report for FSPSAs Initiated During the Report Period Center: 02
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: 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 1959 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 2.008675 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 3 3 2.008675 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 24 25 15.093150 $732.0200 $48.5000
EXIT -EXIT EXIT ASSESSMENT 50 50 43.736986 $2186.8500 $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 9 9 15.005479 $832.8100 $55.5000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 0.227397 $11.6100 $51.0500
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Subtotal (Total Children Is Unduplicated) 83 93 85.068491 $4588.7000 $53.9400
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 58 61 66.549847 $3327.4700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 0.900000 $22.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 195 206 401.117028 $20055.8500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 101 104 181.199999 $9059.9900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.433333 $10.8300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 18 18 32.533332 $1626.6600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 175 176 280.900004 $14045.0200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 3.666667 $91.6700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 9 9 43.357143 $2167.8600 $50.0000
INTR -T1013 INTERPRETER 24 46 91.558806 $4577.9400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 238 447 1675.117691 $16751.1700 $10.0000
PHY -97110 PT SESSION BY LICENSED PT 1 1 5.357143 $382.7100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 6.714286 $383.7900 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 3 21.714286 $1551.2700 $71.4400
TRAV -TRAVS Travel by mile 310 788 122216.196757 $54386.2100 $0.4500
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Subtotal (Total Children Is Unduplicated) 332 1863 125027.316322 $128440.9400 $1.0300
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Total 1959 125114.393488 $133029.6400 $1.0600
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Number of Children (Unduplicated) With at Least One Authorization 355