Summary Report for FSPSAs Initiated During the Report Period Center: 02
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 1479 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 2 2 4.541270 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 2 4.541270 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 14 15 6.148858 $298.2200 $48.5000
EXIT -EXIT EXIT ASSESSMENT 11 11 19.428571 $971.4300 $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
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 10.285714 $528.7900 $51.4100
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Subtotal (Total Children Is Unduplicated) 27 29 39.863143 $2098.4300 $52.6400
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 35 35 35.395798 $1769.8000 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 3 3 5.005556 $250.2800 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 141 158 258.936078 $12946.8200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 79 82 127.350102 $6367.5300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 3.766667 $94.1700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 11 12 18.561905 $928.1000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 141 143 209.145605 $10457.3200 $50.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 4 4 47.428571 $2371.4300 $50.0000
INTR -T1013 INTERPRETER 24 38 79.571429 $3978.5700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 192 413 1487.572143 $14875.7300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 10.285714 $740.1600 $71.9600
TRAV -TRAVS Travel by mile 235 557 91281.581873 $40620.3000 $0.4500
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Subtotal (Total Children Is Unduplicated) 249 1448 93564.601441 $95400.2000 $1.0200
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Total 1479 93609.005854 $97498.6300 $1.0400
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Number of Children (Unduplicated) With at Least One Authorization 256