Summary Report for FSPSAs Initiated During the Report Period Center: 09
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 1434 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 33 34 40.387302 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 33 34 40.387302 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 3 3 4.400000 $220.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 3 3 4.400000 $220.0000 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 175 217 263.129486 $13156.5000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 93 95 72.518214 $1812.9600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 44 45 46.608732 $2330.4500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 25 26 32.273810 $1613.6900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 27 28 29.343651 $1467.1900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 36 36 41.817460 $2090.8800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 3.000000 $75.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 591 633 3749.725454 $187486.1800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 56 65 358.325401 $25598.7500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 72 77 496.633343 $35479.4700 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 163 171 1278.823823 $91359.1400 $71.4400
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Subtotal (Total Children Is Unduplicated) 731 1397 6373.199374 $362495.1900 $56.8800
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Total 1434 6417.986676 $362715.1900 $56.5200
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Number of Children (Unduplicated) With at Least One Authorization 758