Summary Report for FSPSAs Ending During the Report Period Center: 07
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: 10-01-12 and 12-31-12 Date of Report: 02-16-13 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
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 32 33 1171.058730 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 32 33 1171.058730 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.294444 $4.4200 $15.0000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 1 1 0.416667 $20.2100 $48.5000
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Subtotal (Total Children Is Unduplicated) 2 2 0.711111 $24.6300 $34.6300
EI Services, Class # 03
AUD -HA_FUP AUDIOLOGY SERVICES 1 1 0.294444 $14.7200 $49.9900
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 3 3 17.857143 $446.4300 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 65 74 425.499999 $21274.9900 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 1 1 1.866667 $46.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 14 14 59.895239 $2994.7600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 11 11 43.723811 $2186.1900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 2.733333 $68.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 21 21 122.433334 $6121.6600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 2.428571 $60.7200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 3 3 16.285715 $814.2900 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 3 18.428572 $1250.9300 $67.8800
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 257 298 122743.142849 $61371.5700 $0.5000
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Subtotal (Total Children Is Unduplicated) 260 431 123454.589677 $96651.2500 $0.7800
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Total 466 124626.359518 $96675.8800 $0.7800
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Number of Children (Unduplicated) With at Least One Authorization 292