Summary Report for FSPSAs Initiated During the Report Period Center: 09
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 1231 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 16 17 31.090781 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 16 17 31.090781 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 7 8 20.076188 $1003.8200 $50.0000
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 2.000000 $102.1000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 9 10 23.076188 $1156.9700 $50.1400
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 2.428571 $121.4300 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 142 181 149.917042 $7495.8900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 54 54 30.049994 $751.2500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 34 35 31.195239 $1559.7700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 14 14 12.588890 $629.4500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 28 28 15.331865 $766.5900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 34 35 30.787302 $1539.3700 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 3 3 20.285715 $507.1400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 501 541 3493.825431 $174691.1200 $50.0000
INTR -T1013 INTERPRETER 7 7 22.736507 $1136.8300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 63 67 495.285714 $35383.2000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 77 81 486.326983 $34743.1700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 1.600000 $91.4600 $57.1600
SENS -V5264 EARMOLD 1 1 2.428571 $43.7100 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 137 155 1116.000010 $79726.9800 $71.4400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 654 1204 5910.787834 $339187.3300 $57.3800
-------------------------------------------------------------------------------------------------------------------------------------
Total 1231 5964.954803 $340344.3000 $57.0600
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 664