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: 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 1360 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 10 10 4.253197 $206.2900 $48.5000
EXIT -EXIT EXIT ASSESSMENT 12 12 13.000000 $650.0000 $50.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
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Subtotal (Total Children Is Unduplicated) 23 24 21.253197 $1156.2900 $54.4100
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.180822 $9.0400 $49.9900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 24 25 28.493017 $1424.6500 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 3 3 5.005556 $250.2800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 1.966667 $49.1700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 142 160 247.217024 $12360.8400 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 0.300000 $15.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 65 70 108.248859 $5412.4500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.300000 $7.5000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 15 15 20.666665 $1033.3300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 124 129 200.155117 $10007.7400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 3.133334 $78.3400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 2 2 16.857143 $842.8600 $50.0000
INTR -T1013 INTERPRETER 25 39 91.285715 $4564.2900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 201 394 1380.238824 $13802.3800 $10.0000
TRAV -TRAVS Travel by mile 250 492 76795.373516 $34173.9400 $0.4500
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Subtotal (Total Children Is Unduplicated) 277 1336 78899.422259 $84031.7700 $1.0700
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Total 1360 78920.675456 $85188.0600 $1.0800
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Number of Children (Unduplicated) With at Least One Authorization 280