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: 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 1785 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
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 23 27 30.199620 $1464.6800 $48.5000
EXIT -EXIT EXIT ASSESSMENT 57 57 58.241509 $2912.0800 $50.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 0.005479 $0.4100 $75.2900
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 0.005479 $0.3100 $55.7000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 4 4 8.000000 $600.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 7 7 14.000000 $777.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 4.000000 $300.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 7.000000 $357.3500 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.272222 $13.9000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 87 103 124.724309 $6626.7700 $53.1300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 4 3.134247 $15671.0000 $4999.9300
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 54 58 73.731023 $3686.5400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 5 1.027776 $25.6900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 190 204 375.729653 $18786.5200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 102 102 215.471430 $10773.5800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.666667 $41.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 20 21 30.800002 $1540.0100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.666667 $41.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 169 172 280.033334 $14001.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 5.366668 $134.1700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 8 8 41.871429 $2093.5700 $50.0000
INTR -T1013 INTERPRETER 18 28 59.512828 $2975.6500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 225 398 1653.219315 $16532.1800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 3 3 20.142857 $1439.0000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 2 2 13.285714 $949.1300 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 6.285714 $449.0500 $71.4400
TRAV -TRAVS Travel by mile 260 670 113329.109078 $50431.4600 $0.4500
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Subtotal (Total Children Is Unduplicated) 290 1682 116112.054402 $139572.5300 $1.2000
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Total 1785 116236.778711 $146199.3000 $1.2600
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Number of Children (Unduplicated) With at Least One Authorization 311