Summary Report for FSPSAs Ending During the Report Period Center: 07
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: 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 438 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 27 28 26.858730 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 27 28 26.858730 $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 52 52 50.200003 $2510.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 52 53 51.200003 $2560.0000 $50.0000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 90 100 78.297629 $3914.9300 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 132 152 285.328576 $14266.4500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.000000 $25.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 25 25 44.885713 $2244.2800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 16 17 23.133333 $1156.6700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 47 49 72.276191 $3613.8100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 2.400000 $60.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 5 5 35.285715 $1764.2900 $50.0000
INTR -T1013 INTERPRETER 2 2 18.466667 $923.3400 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 4.285714 $306.1700 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1 1 5.428571 $387.8200 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 4.285714 $306.1700 $71.4400
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Subtotal (Total Children Is Unduplicated) 201 357 577.073823 $34018.9100 $58.9500
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Total 438 655.132556 $36578.9000 $55.8300
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Number of Children (Unduplicated) With at Least One Authorization 263