Summary Report for FSPSAs Initiated During the Report Period Center: 07
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 568 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 16 16 30.423809 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 16 16 30.423809 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 60 61 53.030594 $2651.5400 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 61 62 54.030594 $2702.5900 $50.0200
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 103 116 84.199612 $4210.0300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 14 16 12.894445 $322.3600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 162 177 397.357146 $19867.8700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 3 3.857143 $96.4300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 67 71 108.100000 $5405.0000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 25 25 61.947619 $3097.3800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 60 70 115.028571 $5751.4300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 2.833333 $70.8300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 5 5 36.000001 $1800.0000 $50.0000
INTR -T1013 INTERPRETER 3 4 12.652381 $632.6200 $50.0000
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Subtotal (Total Children Is Unduplicated) 233 490 835.870251 $41278.9400 $49.3800
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Total 568 920.324654 $43981.5200 $47.7900
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Number of Children (Unduplicated) With at Least One Authorization 286