Summary Report for FSPSAs Initiated During the Report Period Center: 52
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 581 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 0.555556 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 0.555556 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 3 3 3.000000 $150.0000 $50.0000
SCREEN-T1023 SCREENING 1 1 1.000000 $50.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 4 4 4.000000 $200.0000 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 15 16 19.850001 $992.5100 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 189 235 572.449994 $28622.4700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 100 122 340.433334 $17021.6700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 57 61 148.876185 $7443.7900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 122 127 310.200001 $15510.0100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 3.200000 $80.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 4 4 23.999999 $1200.0100 $50.0000
INTR -T1013 INTERPRETER 9 9 78.561905 $3928.0900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 12.000000 $857.2800 $71.4400
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Subtotal (Total Children Is Unduplicated) 238 576 1509.571419 $75655.8100 $50.1200
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Total 581 1514.126975 $75855.8100 $50.1000
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Number of Children (Unduplicated) With at Least One Authorization 243