Summary Report for FSPSAs Initiated During the Report Period Center: 06
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: 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 922 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 37 37 61.806350 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 37 37 61.806350 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 39 41 91.571429 $4578.5700 $50.0000
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Subtotal (Total Children Is Unduplicated) 39 41 91.571429 $4578.5700 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 112 113 24.922527 $1246.2400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 8 8 2.016668 $50.4200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 7 7 6.283334 $314.1700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 4 2.350000 $58.7500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3 3 2.761112 $138.0600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.083333 $2.0800 $24.9900
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 3 1.227778 $61.3900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 7 7 4.352778 $217.6400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 2.266667 $56.6700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 35 40 271.642855 $13582.1600 $50.0000
INTR -T1013 INTERPRETER 20 25 142.000000 $7100.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 529 618 3692.686571 $36926.8600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 2.033333 $145.2600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 6.100000 $348.9200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 3 3 11.642857 $831.7600 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 5 6 17.714286 $1265.5100 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 0.928571 $12.8900 $13.8800
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Subtotal (Total Children Is Unduplicated) 555 844 4191.012670 $62358.7700 $14.8800
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Total 922 4344.390449 $66937.3400 $15.4100
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Number of Children (Unduplicated) With at Least One Authorization 603