Summary Report for FSPSAs Initiated During the Report Period Center: 01
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: 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 34 34 79.679362 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 34 34 79.679362 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 27 27 24.940183 $1209.5900 $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) 178 189 347.940183 $18049.3400 $51.8700
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 2.000000 $100.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 221 262 312.060426 $15603.0100 $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 48 52 47.076713 $1176.9200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 99 109 252.917459 $12645.8700 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 8 8 12.750001 $637.5100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 7 7 7.566666 $189.1700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 37 40 98.700001 $4935.0100 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 3 3 7.200000 $360.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 16.538096 $413.4500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 50 52 105.477778 $5273.8900 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 3 3 3.466666 $173.3300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 78 79 183.615876 $9180.8100 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 3 3 6.800000 $340.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 6 7.066667 $176.6700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6 6 51.290476 $2564.5200 $50.0000
INTR -T1013 INTERPRETER 115 137 395.907957 $19795.4100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 661 942 5312.699958 $53127.0300 $10.0000
TRAV -TRAVS Travel by mile 661 945 5298.152338 $2357.6800 $0.4400
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Subtotal (Total Children Is Unduplicated) 722 2665 12122.813104 $129126.5500 $10.6500
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Total 2888 12550.432649 $147175.9000 $11.7300
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Number of Children (Unduplicated) With at Least One Authorization 747