Summary Report for FSPSAs Ending During the Report Period Center: 09
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 1444 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 32 32 50.018252 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 32 32 50.018252 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 4.433333 $221.6700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 2 3 3.485714 $174.2900 $50.0000
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Subtotal (Total Children Is Unduplicated) 4 5 7.919047 $395.9500 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 169 210 260.658469 $13032.9500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 90 93 72.400406 $1810.0200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 35 37 37.149064 $1857.4500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 25 28 39.557796 $1977.8900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 1.400000 $35.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 31 35 41.524603 $2076.2400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 0.600000 $15.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 31 31 30.757937 $1537.9000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 4.600000 $115.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 577 646 3925.264265 $196263.3000 $50.0000
INTR -T1013 INTERPRETER 1 1 3.000000 $150.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 42 51 268.023804 $19147.6300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 86 90 558.519048 $39900.6300 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 164 174 1063.261897 $75959.4400 $71.4400
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Subtotal (Total Children Is Unduplicated) 741 1407 6306.717289 $353878.4400 $56.1100
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Total 1444 6364.654588 $354274.3900 $55.6600
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Number of Children (Unduplicated) With at Least One Authorization 770