Summary Report for FSPSAs Ending During the Report Period Center: 52
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 547 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 1 1 0.466667 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 0.466667 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 2 2 2.000000 $100.0000 $50.0000
SCREEN-T1023 SCREENING 1 1 1.000000 $50.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 3 3 3.000000 $150.0000 $50.0000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.811111 $4055.5000 $4999.9300
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 3.366667 $168.3400 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 13 14 14.316667 $715.8400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.366667 $34.1700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 161 207 423.900005 $21195.0300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 106 127 260.783333 $13039.1700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 58 62 129.700002 $6485.0100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 105 116 233.899998 $11694.9900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 5 5 30.857142 $1542.8600 $50.0000
INTR -T1013 INTERPRETER 4 4 23.142857 $1157.1400 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 1.142857 $81.6500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 2 2 21.390476 $1528.1300 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 2.433333 $173.8400 $71.4400
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Subtotal (Total Children Is Unduplicated) 203 543 1147.111115 $61871.6400 $53.9400
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Total 547 1150.577782 $62021.6400 $53.9000
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Number of Children (Unduplicated) With at Least One Authorization 206