Summary Report for FSPSAs Ending During the Report Period Center: 02
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: 10-01-22 and 12-31-22 Date of Report: 01-23-23 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1459 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
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 31 33 18.182267 $881.8400 $48.5000
EXIT -EXIT EXIT ASSESSMENT 18 18 20.002740 $1000.1400 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.533333 $26.6700 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.422222 $21.7100 $51.4100
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Subtotal (Total Children Is Unduplicated) 51 59 51.140562 $2674.3400 $52.2900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.013699 $68.5000 $5000.3600
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.833333 $41.6700 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 23 23 17.053676 $852.6900 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 2 2 3.500000 $175.0000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 170 196 286.504759 $14325.2300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 76 78 122.319046 $6115.9500 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 1 1 2.000000 $100.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.266667 $31.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 18 19 25.376189 $1268.8100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 148 157 224.776189 $11238.8100 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 2 2 4.400000 $220.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 3.333333 $83.3300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 2 2 11.428572 $571.4300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 2 2 14.071429 $703.5700 $50.0000
INTR -T1013 INTERPRETER 19 30 67.684051 $3384.2000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 207 404 1409.810253 $14098.1000 $10.0000
PHY -97110 PT SESSION BY LICENSED PT 1 1 1.428571 $102.8000 $71.9600
TRAV -TRAVS Travel by mile 227 478 76194.478153 $33906.5400 $0.4500
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Subtotal (Total Children Is Unduplicated) 258 1400 78390.277920 $87288.2800 $1.1100
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Total 1459 78441.418482 $89962.6200 $1.1500
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Number of Children (Unduplicated) With at Least One Authorization 267