Summary Report for FSPSAs Initiated During the Report Period Center: 01
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: 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 2807 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 5.377778 $198.9800 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 41 42 184.310318 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 43 44 189.688096 $198.9800 $1.0500
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 22 26 23.825192 $1155.5200 $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
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 103 113 196.825192 $9967.5700 $50.6400
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.300000 $15.0000 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $230.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 191 219 287.406414 $14370.3300 $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 134 147 136.961349 $3424.0400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 104 116 229.132538 $11456.6200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 7 8 13.166667 $329.1700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 38 41 66.394445 $3319.7300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 5.433334 $135.8400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 52 57 92.735713 $4636.7800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 8.142857 $203.5700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 80 86 139.507936 $6975.4000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 7.300001 $182.5000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 15 16 90.485715 $4524.2900 $50.0000
INTR -T1013 INTERPRETER 68 79 240.202382 $12010.1200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 643 935 5113.915056 $51139.1700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 4.733333 $338.1500 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 3 10.447619 $746.3700 $71.4400
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 9.000000 $333.0000 $37.0000
TRAV -TRAVS Travel by mile 644 929 5075.096010 $2258.4200 $0.4500
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Subtotal (Total Children Is Unduplicated) 683 2650 11532.361369 $116678.4700 $10.1200
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Total 2807 11918.874657 $126845.0200 $10.6400
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Number of Children (Unduplicated) With at Least One Authorization 715