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: 10-01-18 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 1402 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 15 15 20.776191 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 15 15 20.776191 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 4.571429 $228.5700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 11.857143 $592.8600 $50.0000
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Subtotal (Total Children Is Unduplicated) 2 2 16.428572 $821.4300 $50.0000
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.833333 $41.6700 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 167 207 172.291916 $8614.5800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 61 62 47.865679 $1196.6500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 43 43 39.466035 $1973.3000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.466667 $11.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 33 33 38.157763 $1907.8900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 41 44 62.232227 $3111.6200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 53 53 55.525256 $2776.2700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.000000 $25.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 556 590 3986.981010 $199348.9800 $50.0000
INTR -T1013 INTERPRETER 3 3 14.857143 $742.8600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 57 62 375.752389 $26843.7400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 4.571429 $261.4800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 102 108 720.058740 $51440.9600 $71.4400
SENS -V5264 EARMOLD 1 1 0.833333 $15.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 169 175 1248.171450 $89169.3400 $71.4400
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Subtotal (Total Children Is Unduplicated) 754 1385 6769.064370 $387481.0000 $57.2400
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Total 1402 6806.269133 $388302.4200 $57.0500
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Number of Children (Unduplicated) With at Least One Authorization 767