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: 01-01-17 and 03-31-17 Date of Report: 05-05-17 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1125 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 9 10 18.244444 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 9 10 18.244444 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 11 12 44.190475 $2209.5200 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 13 14 46.190475 $2311.6200 $50.0500
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 117 141 112.425298 $5621.3000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 52 56 26.150473 $653.7700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 46 48 64.524600 $3226.2300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 18 18 43.873810 $2193.6900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 31 33 59.738455 $2986.9200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 39 41 69.117459 $3455.8800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 2.000000 $50.0000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 2 3 9.000000 $225.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 430 463 2619.157138 $130957.9100 $50.0000
INTR -T1013 INTERPRETER 2 2 11.428571 $571.4300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 53 59 374.509530 $26754.9500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 5.285714 $302.3400 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 70 76 420.605481 $30048.0600 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 144 159 1031.285708 $73675.0600 $71.4400
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Subtotal (Total Children Is Unduplicated) 580 1101 4849.102237 $280722.5200 $57.8900
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Total 1125 4913.537156 $283034.1400 $57.6000
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Number of Children (Unduplicated) With at Least One Authorization 587