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 260 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 14 14 19.709524 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 14 14 19.709524 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 4.571429 $228.5700 $50.0000
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Subtotal (Total Children Is Unduplicated) 1 1 4.571429 $228.5700 $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 64 87 47.043040 $2352.1300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 13 14 9.327266 $233.1800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 25 25 24.701272 $1235.0700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.466667 $11.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 21 21 29.753795 $1487.6900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 29 30 52.761908 $2638.1100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 35 35 43.946033 $2197.3100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 5 5 29.052381 $1452.6200 $50.0000
INTR -T1013 INTERPRETER 1 1 5.714286 $285.7200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 4 39.857143 $2847.4000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 11 11 85.295238 $6093.5000 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 10 10 77.571431 $5541.7100 $71.4400
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Subtotal (Total Children Is Unduplicated) 142 245 446.323793 $26417.7500 $59.1900
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Total 260 470.604746 $26646.3200 $56.6200
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Number of Children (Unduplicated) With at Least One Authorization 157