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: 07-01-20 and 06-30-21 Date of Report: 07-15-21 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 656 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 24 30 72.988889 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 24 30 72.988889 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 5 6 6.000000 $291.0000 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.000000 $23.7000 $23.7000
EXIT -EXIT EXIT ASSESSMENT 1 1 2.000000 $100.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 7 8 9.000000 $414.7000 $46.0800
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 17 22 19.261112 $963.0600 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 34 36 27.999999 $1400.0100 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5 5 7.255556 $362.7800 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 20 22 87.475397 $4373.7800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 3 3.933333 $98.3300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 42 48 131.160318 $6558.0200 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 86 110 279.138884 $13956.9200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 10 11 41.683333 $1042.0800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 12 13 28.727778 $1436.3900 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 35 45 174.821426 $8741.0700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 2 17.400000 $435.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 38 45 97.911112 $4895.5600 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 56 64 139.408727 $6970.4200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 12 13 20.644444 $516.1100 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 3 3 8.333333 $416.6700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1 1 2.533333 $126.6700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 11 12 118.923810 $5946.1900 $50.0000
INTR -T1013 INTERPRETER 1 1 3.733333 $186.6700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 115 158 1106.090476 $11060.9000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 4.000000 $285.7600 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 20.857143 $1490.0300 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 2.000000 $142.8800 $71.4400
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Subtotal (Total Children Is Unduplicated) 341 618 2344.292847 $71455.2800 $30.4800
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Total 656 2426.281736 $71869.9800 $29.6200
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Number of Children (Unduplicated) With at Least One Authorization 362