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: 04-01-20 and 06-30-20 Date of Report: 07-20-20 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 3042 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 1 1 0.166667 $6.1700 $37.0100
SCONLY-SCONLY *SERVICE COORDINATION ONLY 62 64 235.447619 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 10 10 184.622222 $6831.0200 $37.0000
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Subtotal (Total Children Is Unduplicated) 71 75 420.236508 $6837.1900 $16.2700
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 16 19 15.660274 $759.5200 $48.5000
EXIT -EXIT EXIT ASSESSMENT 82 82 164.000000 $8200.0000 $50.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 2 3 6.000000 $450.0000 $75.0000
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Subtotal (Total Children Is Unduplicated) 97 105 187.660274 $9520.5200 $50.7300
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 5 5 4.711111 $235.5600 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 197 225 291.795302 $14589.7700 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 1 1 1.000000 $50.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 135 148 138.461349 $3461.5400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 84 98 170.087303 $8504.3800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 5 6.133333 $153.3300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 36 40 57.683332 $2884.1600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.500000 $12.5000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 51 52 78.666666 $3933.3300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 76 83 118.211109 $5910.5500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 28 28 188.261901 $9413.1000 $50.0000
INTR -T1013 INTERPRETER 71 81 246.629365 $12331.4700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 737 1049 5028.680143 $50286.8000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 3.000000 $214.3200 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 3 13.428572 $959.3300 $71.4400
TRAV -TRAVS Travel by mile 733 1042 5004.613475 $2227.0500 $0.4400
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Subtotal (Total Children Is Unduplicated) 805 2862 11351.862961 $115167.1700 $10.1500
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Total 3042 11959.759743 $131524.8800 $11.0000
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Number of Children (Unduplicated) With at Least One Authorization 853