Summary Report for FSPSAs Initiated During the Report Period Center: 07
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 405 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 20 20 29.284920 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 20 20 29.284920 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 48 48 51.900003 $2594.9900 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.127778 $6.5200 $51.0600
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Subtotal (Total Children Is Unduplicated) 49 49 52.027781 $2601.5100 $50.0000
EI Services, Class # 03
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.944444 $47.2200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 88 98 83.956756 $4197.8900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 2 5.133334 $128.3400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 122 140 341.057144 $17052.8500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 2.066667 $51.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 31 32 73.114286 $3655.7100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 18 18 38.700002 $1935.0100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 33 35 75.928570 $3796.4300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 3.533334 $88.3400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 4 5 52.285714 $2614.2900 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 3.285714 $234.7300 $71.4400
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Subtotal (Total Children Is Unduplicated) 185 336 681.005965 $33852.4600 $49.7100
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Total 405 762.318666 $36453.9800 $47.8200
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Number of Children (Unduplicated) With at Least One Authorization 244