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: 01-01-18 and 03-31-18 Date of Report: 05-05-18 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1193 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 19 20 26.860319 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 19 20 26.860319 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.300000 $15.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 5 5 14.390476 $719.5300 $50.0000
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 0.050000 $2.5500 $51.0500
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Subtotal (Total Children Is Unduplicated) 7 7 14.740476 $737.0800 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 129 159 147.984310 $7399.2300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 46 46 34.586460 $864.6600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 38 38 27.603283 $1380.1700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 22 22 10.149392 $507.4700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 25 27 16.580442 $829.0300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 23 23 15.663492 $783.1800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 3.377778 $84.4500 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 11.285714 $282.1400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 525 561 3152.087311 $157604.2200 $50.0000
INTR -T1013 INTERPRETER 1 2 9.285714 $464.2900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 56 63 388.109523 $27726.5500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 73 80 469.557148 $33545.1600 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 125 140 914.847622 $65356.6800 $71.4400
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Subtotal (Total Children Is Unduplicated) 664 1166 5201.118189 $296827.2000 $57.0700
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Total 1193 5242.718984 $297564.2800 $56.7600
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Number of Children (Unduplicated) With at Least One Authorization 678