Summary Report for FSPSAs Ending During the Report Period Center: 03
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: 07-01-19 and 09-30-19 Date of Report: 11-04-19 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 838 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 48 49 40.074606 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 48 49 40.074606 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 18 21 15.271307 $740.6500 $48.5000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 0.600000 $30.6300 $51.0500
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Subtotal (Total Children Is Unduplicated) 20 23 15.871307 $771.2800 $48.6000
EI Services, Class # 03
CONIF -CONIF CONSULT, ITDS FACE TO FACE 226 264 338.826184 $16941.2800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 107 117 116.699998 $5834.9900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 104 122 137.291272 $6864.5800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 217 237 283.463485 $14173.1400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 16 19 89.998413 $4499.9200 $50.0000
INTR -T1013 INTERPRETER 2 2 5.314286 $265.7200 $50.0000
PHY -97110 PT SESSION BY LICENSED PT 1 2 0.755556 $53.9800 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 3 16.895239 $1206.9900 $71.4400
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Subtotal (Total Children Is Unduplicated) 326 766 989.244433 $49840.5900 $50.3800
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Total 838 1045.190346 $50611.8800 $48.4200
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Number of Children (Unduplicated) With at Least One Authorization 373