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 3963 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 37 39 119.659525 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 16 16 307.571427 $11380.1500 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 54 57 427.919841 $11405.6400 $26.6500
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) 1 1 1.000000 $84.8400 $84.8400
EXIT -EXIT EXIT ASSESSMENT 164 166 331.000000 $16550.0000 $50.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 2 3.000000 $225.0000 $75.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 3 3 5.000000 $375.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 13 13 24.000000 $1332.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 12 13 25.000000 $1875.0000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 3 4.000000 $204.2000 $51.0500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 203 227 418.013623 $21821.6300 $52.2000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 2.000000 $10000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 2.000000 $100.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 296 326 395.444568 $19772.2400 $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 61 66 105.783331 $5289.1600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 7.366667 $184.1700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 33 37 216.757143 $10837.8600 $50.0000
INTR -T1013 INTERPRETER 136 158 441.773812 $22088.7000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 856 1341 5982.020265 $59820.1900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 0.800000 $57.1500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1 2 4.714286 $336.7900 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 2 10.857143 $775.6400 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 2 12.857143 $178.4600 $13.8800
TRAV -TRAVS Travel by mile 952 1510 6217.434551 $2766.7600 $0.4400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1011 3679 13795.346420 $149782.6600 $10.8600
-------------------------------------------------------------------------------------------------------------------------------------
Total 3963 14641.279884 $183009.9400 $12.5000
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1046