Summary Report for FSPSAs Initiated During the Report Period Center: 54
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 1410 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 5 5 4.544444 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 5 4.544444 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 29 33 35.788889 $1735.7600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $56.4900 $56.4900
EXIT -EXIT EXIT ASSESSMENT 48 51 64.209872 $3210.5000 $50.0000
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Subtotal (Total Children Is Unduplicated) 75 85 100.998761 $5002.7500 $49.5300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 10 10 20.477778 $102389.0000 $5000.0100
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.544444 $27.2200 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 97 107 93.766671 $4688.3600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 5 3.255556 $81.3900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 47 54 50.605556 $2530.2800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 81 82 61.379783 $3068.9900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.691667 $17.2900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 68 69 55.205554 $2760.2700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 109 111 80.559524 $4027.9800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 3.088889 $77.2200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 13 17 104.166667 $5208.3400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 3 3 4.609524 $230.4800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 490 850 3093.265119 $30932.6500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 3 3 11.004763 $786.1800 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 1.714286 $122.4700 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 4 20.998413 $1500.1300 $71.4400
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Subtotal (Total Children Is Unduplicated) 497 1320 3605.334194 $158448.2500 $43.9500
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Total 1410 3710.877399 $163451.0000 $44.0500
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Number of Children (Unduplicated) With at Least One Authorization 505