Summary Report for FSPSAs Initiated During the Report Period Center: 03
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: 10-01-19 and 12-31-19 Date of Report: 02-01-20 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 562 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 55 56 36.299770 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 55 56 36.299770 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 14 19 12.556165 $608.9800 $48.5000
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 2 0.338889 $17.3000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 2 0.338889 $17.3000 $51.0500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 15 23 13.233943 $643.5800 $48.6300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 1.138889 $5694.5000 $5000.0500
CONIF -CONIF CONSULT, ITDS FACE TO FACE 127 143 209.665073 $10483.2300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 82 93 104.322219 $5216.1000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 49 55 71.387305 $3569.3900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 144 161 172.016672 $8600.8600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 22 25 102.863490 $5143.1800 $50.0000
INTR -T1013 INTERPRETER 1 1 9.000000 $450.0000 $50.0000
PHY -97110 PT SESSION BY LICENSED PT 1 2 2.033333 $145.2600 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 4.428571 $316.3800 $71.4400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 232 483 676.855552 $39618.8800 $58.5300
-------------------------------------------------------------------------------------------------------------------------------------
Total 562 726.389265 $40262.4600 $55.4300
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 287