Summary Report for FSPSAs Initiated During the Report Period Center: 54
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: 01-01-23 and 03-31-23 Date of Report: 04-20-23 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1338 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 4 4 4.211111 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 4 4 4.211111 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 57 73 62.665870 $3039.2800 $48.5000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 0.283333 $4.4900 $15.8400
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 0.283333 $24.6300 $86.9300
EXIT -EXIT EXIT ASSESSMENT 1 1 2.000000 $100.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 59 76 65.232536 $3168.3900 $48.5700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 10 11 11.855556 $59278.0000 $5000.0200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 149 182 152.475399 $7623.7800 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 13 17 11.016666 $550.8300 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 35 44 45.525398 $2276.2800 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 2 2 1.000000 $50.0000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.433333 $10.8300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 87 89 55.133333 $2756.6700 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 6 6 3.855555 $192.7800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 42 46 31.527779 $1576.4000 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 1 1 1.533333 $76.6700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 134 143 102.423812 $5121.2000 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 1 1 0.133333 $6.6700 $49.9900
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.444444 $36.1100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1 1 2.200000 $110.0000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 2 5.428572 $271.4300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 375 709 2101.496817 $21014.9900 $10.0000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 1.266667 $91.1500 $71.9600
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Subtotal (Total Children Is Unduplicated) 388 1258 2528.749997 $101043.7600 $39.9600
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Total 1338 2598.193644 $104212.1500 $40.1100
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Number of Children (Unduplicated) With at Least One Authorization 390