Summary Report for FSPSAs Ending During the Report Period Center: 09
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 1427 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 34 35 60.341270 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 34 35 60.341270 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 4 4 12.309524 $615.4800 $50.0000
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Subtotal (Total Children Is Unduplicated) 4 4 12.309524 $615.4800 $50.0000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 137 173 223.323872 $11166.2000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 101 118 97.593711 $2439.8400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 34 37 38.877775 $1943.8800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 16 16 18.438890 $921.9500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 27 27 27.886507 $1394.3200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 29 32 36.639681 $1831.9800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 2.000000 $50.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 581 651 4008.685706 $200434.2900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 0.714286 $35.7200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 62 67 361.577777 $25831.1100 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 74 78 410.313489 $29312.7800 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 165 184 1099.723804 $78564.2800 $71.4400
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Subtotal (Total Children Is Unduplicated) 727 1388 6327.775498 $358951.3300 $56.7300
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Total 1427 6400.426292 $359566.8100 $56.1800
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Number of Children (Unduplicated) With at Least One Authorization 757