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: 01-01-22 and 03-31-22 Date of Report: 04-16-22 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2732 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 52 54 102.296031 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 52 54 102.296031 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 18 18 15.547945 $754.0800 $48.5000
EXIT -EXIT EXIT ASSESSMENT 26 26 52.000000 $2600.0000 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 5 5 10.000000 $750.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 5 5 10.000000 $555.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 7 8 16.000000 $1200.0000 $75.0000
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 1.000000 $52.5700 $52.5700
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Subtotal (Total Children Is Unduplicated) 56 67 112.547945 $6511.6500 $57.8600
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 229 253 285.865688 $14293.2800 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 10 16 1.557535 $77.8700 $49.9900
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 33 34 32.829290 $820.7300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 113 122 213.446029 $10672.2900 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 15 15 20.027777 $1001.3900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 3 9.733333 $243.3300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 45 49 76.311107 $3815.5400 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 2 2 0.611111 $30.5600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 9.519047 $237.9800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 41 46 57.916668 $2895.8400 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 6 6 4.433332 $221.6600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 5.733333 $143.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 75 79 116.569050 $5828.4700 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 11 12 13.727777 $686.3900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 5.366667 $134.1700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 6 6 2.752380 $137.6300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 7 7 49.861906 $2493.0900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 2 2.714285 $135.7200 $50.0000
INTR -T1013 INTERPRETER 96 105 265.283334 $13264.1700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 701 918 5074.033798 $50740.3800 $10.0000
PHY -97110 PT SESSION BY LICENSED PT 1 1 0.466667 $33.3400 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 2 16.714285 $1194.0700 $71.4400
TRAV -TRAVS Travel by mile 704 927 5077.157605 $2259.3300 $0.4400
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Subtotal (Total Children Is Unduplicated) 780 2611 11343.632004 $111410.5100 $9.8200
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Total 2732 11558.475980 $117922.1600 $10.2000
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Number of Children (Unduplicated) With at Least One Authorization 814