Summary Report for FSPSAs Initiated During the Report Period Center: 52
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
Eligibility Filter: Program Patients
With the filters selected there were 697 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 5 5 2.911110 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 5 5 2.911110 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 4 4 4.000000 $200.0000 $50.0000
SCREEN-T1023 SCREENING 3 3 3.033333 $151.6700 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 7 7 7.033333 $351.6700 $50.0000
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 2.800000 $140.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 9 11 33.678571 $1683.9300 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 208 247 600.671432 $30033.5900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 141 171 393.483339 $19674.2000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 2.133333 $53.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 68 69 158.800000 $7940.0000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 140 145 338.866671 $16943.3600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 8.333333 $208.3300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 13 13 49.719049 $2485.9400 $50.0000
INTR -T1013 INTERPRETER 2 2 4.071428 $203.5800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 8 8 58.390477 $4171.4200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 2 2 3.266666 $233.3700 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 11 11 66.423809 $4745.3100 $71.4400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 282 685 1720.638108 $88516.3400 $51.4400
-------------------------------------------------------------------------------------------------------------------------------------
Total 697 1730.582551 $88868.0000 $51.3500
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 293