Summary Report for FSPSAs Ending During the Report Period Center: 07
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 505 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 17 17 11.933332 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 17 17 11.933332 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 56 56 52.656011 $2632.8000 $50.0000
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 2.000000 $102.1000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.250000 $63.8100 $51.0500
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Subtotal (Total Children Is Unduplicated) 59 59 55.906011 $2798.7100 $50.0600
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.246575 $12.3300 $50.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 95 108 84.230962 $4211.6000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 11 13 5.672223 $141.8100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 154 175 361.721422 $18086.0600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 2.000000 $50.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 42 44 72.883334 $3644.1700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 2.166667 $54.1700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 24 24 54.038094 $2701.9100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 50 52 76.380954 $3819.0500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 5 5 42.428571 $2121.4300 $50.0000
INTR -T1013 INTERPRETER 2 3 11.285714 $564.2900 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 6.428571 $459.2600 $71.4400
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Subtotal (Total Children Is Unduplicated) 224 429 719.483087 $35866.0600 $49.8500
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Total 505 787.322430 $38664.7800 $49.1100
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Number of Children (Unduplicated) With at Least One Authorization 279