Summary Report for FSPSAs Ending During the Report Period Center: 06
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: 01-01-20 and 03-31-20 Date of Report: 05-15-20 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 905 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 32 33 37.111113 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 32 33 37.111113 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 41 43 86.000000 $4300.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 41 43 86.000000 $4300.0000 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 99 102 25.440227 $1272.1400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 10 10 5.520835 $138.0300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 9 9 10.992856 $549.6400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 4 4.450000 $111.2500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 5 5 8.876190 $443.8100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.750000 $18.7500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 3 4 5.609524 $280.4800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4 4 5.476190 $273.8100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.900000 $47.5000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 26 30 196.361904 $9818.1000 $50.0000
INTR -T1013 INTERPRETER 30 31 69.247619 $3462.3800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 507 610 3493.124598 $34931.2500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 3 3 17.040476 $1217.3700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 4.783333 $273.6000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 6 6 21.428572 $1530.8600 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 7 7 27.928572 $1995.2200 $71.4400
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Subtotal (Total Children Is Unduplicated) 541 829 3898.930896 $56364.1700 $14.4600
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Total 905 4022.042009 $60664.1700 $15.0800
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Number of Children (Unduplicated) With at Least One Authorization 575