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: 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 1239 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 11 11 21.744748 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 11 11 21.744748 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 11 15 27.768252 $1388.4200 $50.0000
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 0.366667 $18.7200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 13 17 29.134919 $1458.1900 $50.0500
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 151 192 166.195132 $8309.7800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 58 58 32.088731 $802.2200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 28 30 23.327778 $1166.3900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 7 7 6.444445 $322.2300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 23 25 13.933310 $696.6600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 21 22 16.694446 $834.7300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 486 539 3076.919043 $153845.9900 $50.0000
INTR -T1013 INTERPRETER 7 8 34.593650 $1729.6800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 54 62 343.500001 $24539.6400 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 90 99 522.767465 $37346.4900 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 142 169 875.314284 $62532.4600 $71.4400
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Subtotal (Total Children Is Unduplicated) 667 1211 5111.778285 $292126.2500 $57.1500
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Total 1239 5162.657952 $293584.4400 $56.8700
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Number of Children (Unduplicated) With at Least One Authorization 676