Summary Report for FSPSAs Ending During the Report Period Center: 01
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: 01-01-20 and 03-31-20 Date of Report: 05-15-20 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 6156 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 2 2 0.688889 $25.4900 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 43 45 157.205232 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 539 543 13658.887304 $505378.8600 $37.0000
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Subtotal (Total Children Is Unduplicated) 551 590 13816.781425 $505404.3500 $36.5800
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 23 23 20.013623 $970.6600 $48.5000
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 2 4.000000 $153.8800 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 8 8 9.000000 $763.5600 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 1.000000 $51.0700 $51.0700
EXIT -EXIT EXIT ASSESSMENT 170 172 343.000000 $17150.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 1.500000 $112.5000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 12 12 22.000000 $1650.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 1.500000 $112.5000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 18 27 50.000000 $3750.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 13 21 39.000000 $2164.5000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 98 98 177.000000 $13275.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 16 16 26.500000 $1987.5000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 9 9 16.000000 $1200.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 240 241 434.500000 $24114.7500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 203 242 433.000000 $32475.0000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 3 3 2.106849 $107.5500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 7 7 11.000000 $561.5500 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.0500 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 1.106849 $56.5000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 7 8 10.000000 $510.5000 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 4 4 5.000000 $255.2500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 2.000000 $102.1000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 12 14 25.857143 $1320.0100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 1.000000 $51.0500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 4.000000 $178.2000 $44.5500
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Subtotal (Total Children Is Unduplicated) 552 921 1643.084464 $103226.7800 $62.8300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 21 21 23.232574 $116163.5000 $5000.0300
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 3 3.000000 $150.0000 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.783333 $56.0900 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 5 5 5.466667 $1257.3400 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 298 328 398.444568 $19922.2400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 38 39 45.385922 $1134.6500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 95 103 177.734126 $8886.7000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.666667 $41.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 30 31 51.316666 $2565.8300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 49 54 78.434130 $3921.7200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 41.000000 $1025.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 62 67 107.016664 $5350.8200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 7.366667 $184.1700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 701 757 4388.476185 $219423.8000 $50.0000
INTR -T1013 INTERPRETER 138 160 444.773812 $22238.7000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 858 1343 5998.305979 $59983.0500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 39 41 246.652382 $17620.8500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 3 3 7.266667 $415.6600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 73 77 400.779366 $28631.6500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 7 7 16.457144 $940.7000 $57.1600
SENS -V5264 EARMOLD 2 2 2.957991 $53.2400 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 73 76 467.557146 $33402.2600 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 7.428571 $530.7000 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 10 11 79.723811 $1106.5700 $13.8800
TRAV -TRAVS Travel by mile 953 1511 6224.720265 $2770.0000 $0.4400
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Subtotal (Total Children Is Unduplicated) 1023 4645 19225.947303 $547776.8900 $28.4900
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Total 6156 34685.813192 $1156408.0300 $33.3400
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Number of Children (Unduplicated) With at Least One Authorization 1199