Summary Report for FSPSAs Ending During the Report Period Center: 54
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 1456 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 3.199999 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 3 3 3.199999 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 30 33 24.444447 $1185.5700 $48.5000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.000000 $45.0000 $45.0000
EXIT -EXIT EXIT ASSESSMENT 49 52 101.293074 $5064.6600 $50.0000
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Subtotal (Total Children Is Unduplicated) 76 86 126.737521 $6295.2200 $49.6700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 14 15 30.900000 $154500.0000 $5000.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.000000 $71.6100 $71.6100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 98 113 111.145587 $5557.2900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 5 3.255556 $81.3900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 52 58 38.080156 $1904.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 79 86 61.367085 $3068.3600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.238889 $5.9700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 58 59 64.188888 $3209.4400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 123 131 85.527776 $4276.3800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 3 3.850001 $96.2500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 21 26 144.803175 $7240.1700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 454 856 2716.054004 $27160.5400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 5 5 26.366667 $1883.6400 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 2 2 2.733334 $195.2700 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4 6 17.722223 $1266.0900 $71.4400
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Subtotal (Total Children Is Unduplicated) 459 1367 3307.233341 $210516.3900 $63.6500
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Total 1456 3437.170861 $216811.6100 $63.0800
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Number of Children (Unduplicated) With at Least One Authorization 465