Summary Report for FSPSAs Ending During the Report Period Center: 06
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: 10-01-18 and 12-31-18 Date of Report: 02-06-19 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 881 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 38 38 77.444445 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 38 38 77.444445 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 24 24 48.000000 $2400.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 24 24 48.000000 $2400.0000 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 103 110 14.466032 $723.4400 $50.0100
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 6 6 1.246430 $31.1600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 15 17 13.392858 $669.6500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 5 5 6.016667 $150.4200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 4 4 6.316667 $315.8400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 1.350000 $33.7500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 2.466667 $123.3400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 12 14 13.542857 $677.1500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 4.666667 $116.6700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 20 21 101.571427 $5078.5800 $50.0000
INTR -T1013 INTERPRETER 17 18 69.714285 $3485.7100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 475 575 3361.614281 $33616.1500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 8 8 30.428571 $2173.8200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 11 12 53.857143 $3847.5500 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.024658 $1.6100 $65.1100
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 20 21 76.571429 $5470.2600 $71.4400
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Subtotal (Total Children Is Unduplicated) 494 819 3757.246639 $56515.0700 $15.0400
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Total 881 3882.691084 $58915.0700 $15.1700
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Number of Children (Unduplicated) With at Least One Authorization 529