Summary Report for FSPSAs Ending During the Report Period Center: 52
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 493 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 4 4 2.500000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 4 4 2.500000 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 1.000000 $50.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 6 6 6.000000 $300.0000 $50.0000
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SCREEN-T1023 SCREENING 1 1 1.000000 $50.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 9 9 9.000000 $451.0500 $50.1200
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 3 5.400000 $270.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 7 7 11.083333 $554.1700 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 129 163 392.683334 $19634.1700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 103 134 323.566668 $16178.3400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 50 57 146.266669 $7313.3500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 95 100 246.833333 $12341.6700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6 7 34.857142 $1742.8600 $50.0000
INTR -T1013 INTERPRETER 7 7 55.166668 $2758.3300 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 2 17.714286 $1265.5100 $71.4400
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Subtotal (Total Children Is Unduplicated) 178 480 1233.571433 $62058.3800 $50.3100
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Total 493 1245.071433 $62509.4300 $50.2100
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Number of Children (Unduplicated) With at Least One Authorization 186