Summary Report for FSPSAs Initiated During the Report Period Center: 52
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 421 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
Screening, Eval, and Assessment, Class # 02
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 1.000000 $50.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 4 4 4.000000 $200.0000 $50.0000
SCREEN-T1023 SCREENING 1 1 1.000000 $50.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 6 6 6.000000 $300.0000 $50.0000
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 2.300000 $115.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 9 9 12.483333 $624.1700 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 127 153 335.816665 $16790.8300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 92 102 225.966672 $11298.3600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 39 40 94.700001 $4735.0100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 90 91 190.866668 $9543.3400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 5 7 47.142858 $2357.1500 $50.0000
INTR -T1013 INTERPRETER 8 8 71.495240 $3574.7600 $50.0000
PHY -97110 PT SESSION BY LICENSED PT 1 1 5.666667 $404.8300 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 2 12.142857 $867.4900 $71.4400
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Subtotal (Total Children Is Unduplicated) 181 415 998.580961 $50310.9200 $50.3800
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Total 421 1004.580961 $50610.9200 $50.3800
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Number of Children (Unduplicated) With at Least One Authorization 186