Summary Report for FSPSAs Initiated During the Report Period Center: 53
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: 07-01-19 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 2115 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 19 19 22.111110 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 12.333333 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 20 20 34.444443 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 8 8 6.481888 $314.3700 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.983333 $23.3000 $23.7000
EXIT -EXIT EXIT ASSESSMENT 6 6 9.594444 $479.7200 $50.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 3 18.399999 $920.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 17 18 35.459664 $1737.3900 $49.0000
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 52 62 54.269048 $2713.4600 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 1 1 0.005556 $0.2800 $50.4000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 6 4.500000 $112.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 40 46 136.386509 $6819.3300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 9.857143 $246.4300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 102 126 298.350794 $14917.5500 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 15 15 27.638888 $1381.9400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 33.059524 $826.4900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 69 79 201.093646 $10054.6600 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 7 7 6.022223 $301.1200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.500000 $12.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 61 73 149.523017 $7476.1600 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 17 18 18.522223 $926.1200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 9.777777 $244.4400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 4 5 24.877778 $621.9500 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 8 8 43.740476 $2187.0300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 26 28 312.204762 $15610.2500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 3.800000 $190.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 816 1582 15697.517730 $156975.2100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 36.571428 $2612.6600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 4 5 75.571428 $5398.8300 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 1.857143 $132.6700 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 2 32.523810 $2323.5000 $71.4400
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Subtotal (Total Children Is Unduplicated) 838 2077 17179.170903 $232135.0400 $13.5100
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Total 2115 17249.075010 $233872.4300 $13.5600
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Number of Children (Unduplicated) With at Least One Authorization 849