Summary Report for FSPSAs Initiated During the Report Period Center: 02
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 1113 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 13.030158 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 3 3 13.030158 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 21 22 15.083485 $731.5400 $48.5000
EVAL -96111 DEVELOPMENTAL EVALUATION 2 3 0.366666 $18.3300 $49.9900
EXIT -EXIT EXIT ASSESSMENT 38 38 39.975343 $1998.7700 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 4 4 8.500000 $471.7500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 4.500000 $337.5000 $75.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.060274 $54.1300 $51.0500
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Subtotal (Total Children Is Unduplicated) 65 72 71.485768 $3762.0200 $52.6300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 49 56 68.292296 $3414.6200 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 5 5 3.849999 $192.5000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 15 15 12.020835 $300.5300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 134 147 267.838095 $13391.9300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 78 80 137.790479 $6889.5400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 5.166667 $129.1700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 15 15 21.166667 $1058.3400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 119 123 189.057145 $9452.8700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 5.999999 $150.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 9 9 43.852381 $2192.6300 $50.0000
INTR -T1013 INTERPRETER 13 16 35.773015 $1788.6500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 150 275 1148.404766 $11484.0500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 6.857143 $489.8700 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1 1 13.714286 $979.7500 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 3.142857 $224.5300 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 6.857143 $95.1800 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 2 2 1.000000 $37.0000 $37.0000
TRAV -TRAVS Travel by mile 133 284 63927.809522 $28447.8800 $0.4500
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Subtotal (Total Children Is Unduplicated) 187 1038 65899.593295 $85719.0000 $1.3000
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Total 1113 65984.109221 $89481.0200 $1.3600
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Number of Children (Unduplicated) With at Least One Authorization 215