Summary Report for FSPSAs Ending During the Report Period Center: 54
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 1398 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 6 6 8.221429 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 9.714286 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 7 7 17.935715 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 25 31 41.096825 $1993.1900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $56.4900 $56.4900
EXIT -EXIT EXIT ASSESSMENT 31 34 48.829984 $2441.5000 $50.0000
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Subtotal (Total Children Is Unduplicated) 56 66 90.926809 $4491.1800 $49.3900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 5.700000 $28500.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.177778 $8.8900 $50.0100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.350000 $25.0600 $71.6100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 86 96 78.758332 $3937.9100 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 4 4 4.250000 $212.5000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 4 4 5.500000 $137.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 48 52 53.327778 $2666.3900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 72 76 51.516665 $2575.8300 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 2 3 1.966667 $98.3400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.758333 $18.9600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 68 70 46.663893 $2333.2200 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 1 1 0.211111 $10.5600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 132 138 78.288885 $3914.4300 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 2 2 3.666667 $183.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 2.688889 $67.2200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 16 18 97.341272 $4867.0600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 2 9.485714 $474.2900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 456 842 2703.902381 $27039.0300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 3.333333 $238.1300 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 2.000000 $142.8800 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1 1 2.966667 $211.9400 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 3 18.980953 $1356.0000 $71.4400
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 0.571429 $21.1400 $37.0000
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Subtotal (Total Children Is Unduplicated) 469 1325 3172.406747 $79040.5900 $24.9200
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Total 1398 3281.269271 $83531.7700 $25.4600
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Number of Children (Unduplicated) With at Least One Authorization 477