Summary Report for FSPSAs Initiated During the Report Period Center: 07
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 448 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 21 21 15.144444 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 21 21 15.144444 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 52 52 54.109284 $2705.4700 $50.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 0.071233 $3.9500 $55.4700
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 0.071233 $5.3400 $74.9700
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.333333 $17.0200 $51.0500
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Subtotal (Total Children Is Unduplicated) 54 55 54.585083 $2731.7700 $50.0500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.071233 $3.5600 $49.9800
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 94 107 78.819169 $3940.9900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 7 5.666667 $141.6700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 131 153 306.799992 $15339.9700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 3 7.066666 $176.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 27 28 47.633333 $2381.6700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 2 2.833334 $70.8400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 17 17 27.476189 $1373.8100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 2.833333 $70.8300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 42 42 80.761903 $4038.0900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 3.233333 $80.8300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 3 3 23.857143 $1192.8600 $50.0000
INTR -T1013 INTERPRETER 1 1 19.433333 $971.6700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 9.857143 $704.1900 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1 1 13.142857 $938.9300 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 2 12.571429 $898.1000 $71.4400
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Subtotal (Total Children Is Unduplicated) 203 372 643.057057 $37324.6500 $58.0400
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Total 448 712.786584 $40056.4200 $56.2000
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Number of Children (Unduplicated) With at Least One Authorization 263