Summary Report for FSPSAs Ending During the Report Period Center: 09
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 1374 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 22 22 36.144446 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 22 22 36.144446 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.000000 $50.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 3 3 4.500001 $225.0100 $50.0000
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Subtotal (Total Children Is Unduplicated) 4 4 5.500001 $275.0100 $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 0.100000 $5.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 158 198 238.182433 $11909.1300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 80 82 63.399318 $1584.9900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 33 34 37.643651 $1882.1900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 26 26 42.828571 $2141.4300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 21 22 27.806349 $1390.3200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 2.000000 $50.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 25 25 20.977778 $1048.8900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 3.000000 $75.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 550 614 3509.983314 $175499.2300 $50.0000
INTR -T1013 INTERPRETER 2 2 10.428571 $521.4300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 73 78 418.371425 $29888.4800 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 91 95 538.920630 $38500.5200 $71.4400
SENS -V5264 EARMOLD 1 1 0.100000 $1.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 151 164 1000.938088 $71507.0800 $71.4400
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Subtotal (Total Children Is Unduplicated) 749 1348 5915.680128 $341005.4800 $57.6400
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Total 1374 5957.324575 $341280.4900 $57.2900
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Number of Children (Unduplicated) With at Least One Authorization 766