Summary Report for FSPSAs Ending During the Report Period Center: 09
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: 01-01-16 and 03-31-16 Date of Report: 05-12-16 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1595 FSPSA's found of which 33 had no frequency modifier field, FORCE FREQ MODIFIER to 0
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 3 2.444444 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 3 2.444444 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 4 6 23.284126 $1164.2100 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.072222 $3.6900 $51.0300
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.016667 $0.8500 $51.1500
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Subtotal (Total Children Is Unduplicated) 6 8 23.373015 $1168.7500 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 115 139 16.053750 $802.6700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 52 61 15.151129 $378.7700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 76 146 185.512977 $9275.6400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 5 1.119408 $27.9900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3 3 6.807937 $340.4000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 5 5 4.457936 $222.9000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 7 7 0.465079 $23.2600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 390 435 2470.257152 $123512.8200 $50.0000
INTR -T1013 INTERPRETER 9 9 182.714286 $9135.7200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 62 70 423.903973 $30283.6800 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 94 104 643.114289 $45944.0600 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 147 164 1067.691281 $76275.8300 $71.4400
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 345 436 2240.317443 $1120.1600 $0.5000
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Subtotal (Total Children Is Unduplicated) 625 1584 7257.566640 $297343.8700 $40.9700
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Total 1595 7283.384099 $298512.6200 $40.9900
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Number of Children (Unduplicated) With at Least One Authorization 627