Summary Report for FSPSAs Initiated During the Report Period Center: 06
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: 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 926 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 29 29 43.047621 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 29 29 43.047621 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 42 43 86.000000 $4300.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 42 43 86.000000 $4300.0000 $50.0000
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 1.355556 $67.7800 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 93 93 19.809748 $990.6200 $50.0100
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 9 9 4.520835 $113.0300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 11 11 9.283334 $464.1700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 6 6 3.599999 $90.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 5 5 5.416667 $270.8400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.083333 $2.0800 $24.9900
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 1.100000 $55.0000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.033333 $0.8300 $24.9800
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4 4 3.266667 $163.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.750000 $43.7500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 28 33 176.133332 $8806.6700 $50.0000
INTR -T1013 INTERPRETER 30 34 120.961904 $6048.0900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 530 624 3915.215071 $39152.1500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 3 3 13.000000 $928.7200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 8 10 31.892858 $2278.4300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 3.750000 $214.3500 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 1.000000 $65.0000 $65.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.677778 $309.0800 $456.0100
SENS -V5264 EARMOLD 1 1 0.677778 $12.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 9 9 31.285715 $2235.0400 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 15.714286 $218.1100 $13.8800
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Subtotal (Total Children Is Unduplicated) 556 854 4360.528194 $62529.2700 $14.3400
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Total 926 4489.575815 $66829.2700 $14.8900
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Number of Children (Unduplicated) With at Least One Authorization 598