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: 10-01-21 and 12-31-21 Date of Report: 02-04-22 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 989 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 5 5 4.900000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 5 4.900000 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 44 51 36.105556 $1751.1200 $48.5000
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Subtotal (Total Children Is Unduplicated) 44 51 36.105556 $1751.1200 $48.5000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 7 12.183333 $60916.5000 $4999.9900
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.155556 $7.7800 $50.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 86 99 61.992456 $3099.6100 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 71 89 67.105558 $3355.2900 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 27 31 33.388887 $1669.4400 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 33 45 44.044442 $2202.2100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 47 47 35.173014 $1758.6500 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 40 41 40.194443 $2009.7200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 2.200000 $55.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 33 34 28.072222 $1403.6100 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 19 19 15.150002 $757.5100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 63 64 44.746032 $2237.3000 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 52 55 45.016664 $2250.8200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.833333 $45.8300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1 1 2.355556 $117.7800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 2.355556 $117.7800 $50.0000
INTR -T1013 INTERPRETER 1 1 2.500000 $125.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 224 392 976.167465 $9761.6700 $10.0000
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 0.733333 $52.3900 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 0.466667 $33.3400 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 2 0.400000 $28.5800 $71.4400
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Subtotal (Total Children Is Unduplicated) 346 933 1416.234519 $92005.7900 $64.9700
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Total 989 1457.240075 $93756.9100 $64.3400
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Number of Children (Unduplicated) With at Least One Authorization 349