Summary Report for FSPSAs Ending During the Report Period Center: 06
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 968 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 53 54 73.046030 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 53 54 73.046030 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 46 48 105.571429 $5278.5700 $50.0000
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Subtotal (Total Children Is Unduplicated) 46 48 105.571429 $5278.5700 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 115 120 31.215574 $1560.8900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 6 6 0.516668 $12.9200 $25.0100
CONIF -CONIF CONSULT, ITDS FACE TO FACE 11 11 13.833335 $691.6800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 4 3.650001 $91.2500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 5 5 7.666667 $383.3400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 3.350000 $83.7500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 2.050000 $102.5000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 7 7 7.175002 $358.7600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 4.716667 $117.9200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 27 31 142.933331 $7146.6800 $50.0000
INTR -T1013 INTERPRETER 20 23 57.942857 $2897.1500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 527 629 3441.276982 $34412.7800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 3 3 5.428572 $387.8200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 5 5 22.357144 $1597.1800 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 9 9 31.571430 $2255.4600 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 4 4 8.928572 $123.9300 $13.8800
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Subtotal (Total Children Is Unduplicated) 559 866 3784.612802 $52223.9900 $13.8000
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Total 968 3963.230261 $57502.5600 $14.5100
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Number of Children (Unduplicated) With at Least One Authorization 611