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 243 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 57.674603 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 32 33 57.674603 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 6.142857 $307.1500 $50.0000
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Subtotal (Total Children Is Unduplicated) 1 1 6.142857 $307.1500 $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 60 81 112.821763 $5641.0900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 34 39 35.254740 $881.3700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 20 23 25.933331 $1296.6600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 11 11 13.405556 $670.2800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 13 13 15.919842 $796.0000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 21 24 33.228570 $1661.4200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.000000 $25.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 7 9 54.285715 $2714.2800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 2.000000 $142.8800 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 5 5 46.571429 $3327.0700 $71.4400
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Subtotal (Total Children Is Unduplicated) 110 209 342.420946 $22181.0300 $64.7800
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Total 243 406.238406 $22488.1800 $55.3600
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Number of Children (Unduplicated) With at Least One Authorization 142