Summary Report for FSPSAs Ending During the Report Period Center: 02
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 2363 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 13.285714 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 3 3 13.285714 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 31 33 18.477016 $896.1200 $48.5000
EXIT -EXIT EXIT ASSESSMENT 59 59 61.618049 $3080.9100 $50.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 22 22 44.000000 $3300.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 4 4 8.500000 $637.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 20 20 32.523286 $2439.2500 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 5 5 10.000000 $750.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 56 57 110.951857 $6157.8300 $55.5000
IPDEI -T1024HNUKGT 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 11 11 25.500000 $1912.5000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 4 4 0.563014 $28.7400 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 8 8 2.410960 $123.0800 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 15 16 9.456468 $482.7500 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 6 7 1.057459 $53.9900 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 4 4 1.227398 $62.6600 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 19 20 9.932117 $507.0300 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 1.438889 $73.4600 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.126027 $6.4300 $51.0400
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 20 22 15.557819 $794.2300 $51.0500
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Subtotal (Total Children Is Unduplicated) 183 308 379.340359 $22866.4700 $60.2800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 41 43 33.964850 $169823.0000 $4999.9600
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 55 62 66.014914 $3300.7500 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 4 4 2.016666 $100.8300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 15 15 11.220835 $280.5300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 217 240 388.647619 $19432.3800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 105 114 173.200003 $8660.0200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 2.066667 $51.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 19 19 25.700001 $1285.0100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 202 214 316.561901 $15828.0800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.900000 $22.5000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 236 251 1378.871415 $68943.6100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 2 14.000000 $700.0000 $50.0000
INTR -T1013 INTERPRETER 12 17 49.565079 $2478.2600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 245 426 1640.142847 $16401.4400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 48 51 306.678569 $21909.1200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 5.714286 $326.8600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 43 47 251.908330 $17996.3400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 3 9.620743 $549.9300 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 36 41 248.928569 $17783.4400 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 3.571429 $49.5700 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 2 2 1.000000 $37.0000 $37.0000
TRAV -TRAVS Travel by mile 231 497 103255.670263 $45948.7700 $0.4500
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Subtotal (Total Children Is Unduplicated) 297 2052 108185.964986 $411909.0900 $3.8100
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Total 2363 108578.591059 $434775.5600 $4.0000
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Number of Children (Unduplicated) With at Least One Authorization 361