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: 10-01-18 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 1311 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 33.679366 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 16 17 33.679366 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 0.566667 $28.3400 $50.0000
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Subtotal (Total Children Is Unduplicated) 1 1 0.566667 $28.3400 $50.0000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.188889 $9.4500 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 3.142857 $225.0600 $71.6100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 155 190 160.647136 $8032.3600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 60 61 48.419647 $1210.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 38 39 36.675396 $1833.7700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 17 18 17.597730 $879.9000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 30 33 25.680214 $1284.0200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 32 34 27.121537 $1356.0800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.000000 $25.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 561 611 3445.719027 $172286.0500 $50.0000
INTR -T1013 INTERPRETER 3 3 41.714286 $2085.7200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 57 62 378.433334 $27035.2900 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 91 96 532.590476 $38048.2500 $71.4400
SENS -V5264 EARMOLD 1 1 0.188889 $3.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 133 140 719.000000 $51365.4100 $71.4400
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Subtotal (Total Children Is Unduplicated) 722 1293 5440.119418 $310705.2300 $57.1100
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Total 1311 5474.365451 $310733.5700 $56.7600
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Number of Children (Unduplicated) With at Least One Authorization 734