Summary Report for FSPSAs Ending During the Report Period Center: 01
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: 10-01-20 and 12-31-20 Date of Report: 01-23-21 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2888 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 47 49 85.927779 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 47 49 85.927779 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 23 25 17.838356 $865.1600 $48.5000
EXIT -EXIT EXIT ASSESSMENT 142 144 288.000000 $14400.0000 $50.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 1.500000 $112.5000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 1.500000 $83.2500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 5 5 10.000000 $750.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 4 4 8.000000 $444.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 6 7 14.000000 $1050.0000 $75.0000
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Subtotal (Total Children Is Unduplicated) 173 187 340.838356 $17704.9100 $51.9500
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 219 257 301.588204 $15079.4000 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 5 6 1.526026 $76.3100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 46 51 41.815069 $1045.3800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 98 111 194.985713 $9749.2800 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 2.000000 $100.0000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 7 7 8.200000 $205.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 39 44 74.211107 $3710.5400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 13.309524 $332.7400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 47 50 78.290479 $3914.5400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 5.000000 $125.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 82 85 136.267458 $6813.3700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 3.700000 $92.5000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 15 17 138.857144 $6942.8600 $50.0000
INTR -T1013 INTERPRETER 120 141 378.522246 $18926.1300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 612 937 4426.488916 $44264.8900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 5.428571 $387.8200 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 2 14.428571 $1030.7800 $71.4400
TRAV -TRAVS Travel by mile 616 937 4398.760347 $1957.4500 $0.4500
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Subtotal (Total Children Is Unduplicated) 722 2652 10223.379375 $114753.9600 $11.2200
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Total 2888 10650.145510 $132458.8700 $12.4400
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Number of Children (Unduplicated) With at Least One Authorization 757