Summary Report for FSPSAs Initiated During the Report Period Center: 06
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: 10-01-17 and 12-31-17 Date of Report: 02-03-18 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 787 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 29 29 41.013492 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 29 29 41.013492 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 12 12 24.000000 $1200.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 12 12 24.000000 $1200.0000 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 114 116 4.265234 $213.4700 $50.0500
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 7 7 0.187501 $4.6900 $25.0100
CONIF -CONIF CONSULT, ITDS FACE TO FACE 16 16 18.361111 $918.0600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 3 1.850001 $46.2500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 7 7 6.305556 $315.2800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 1.183334 $29.5900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 9 9 14.366665 $718.3300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 0.883334 $22.0900 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 15 16 21.368253 $1068.4100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.866667 $46.6700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 15 15 84.857143 $4242.8600 $50.0000
INTR -T1013 INTERPRETER 9 12 51.000000 $2550.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 408 503 3078.004007 $30780.0100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 6 7 33.071427 $2362.6200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 14 14 50.935714 $3638.8500 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 13 14 64.250000 $4590.0300 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 3.000000 $41.6400 $13.8800
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Subtotal (Total Children Is Unduplicated) 425 746 3435.755947 $51588.8200 $15.0200
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Total 787 3500.769439 $52788.8200 $15.0800
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Number of Children (Unduplicated) With at Least One Authorization 450