Summary Report for FSPSAs Initiated During the Report Period Center: 09
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 1360 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 25 25 42.930159 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 25 25 42.930159 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 5 5 14.157142 $707.8500 $50.0000
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Subtotal (Total Children Is Unduplicated) 5 5 14.157142 $707.8500 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 138 172 223.971815 $11198.5900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 107 124 105.619129 $2640.4800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 25 25 22.255555 $1112.7800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.300000 $7.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 10 10 11.955556 $597.7800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 12 12 10.611111 $530.5600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 25 26 28.061110 $1403.0500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 2.494445 $62.3600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 558 603 3735.711893 $186785.6800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 15 15 41.857143 $2092.8600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 55 62 378.654761 $27051.1000 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 2.714286 $193.9100 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 78 84 520.623014 $37193.3200 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 2 2 7.980953 $570.1600 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 167 183 1209.228572 $86387.2900 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 3 2.266667 $161.9300 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 9.000000 $642.9600 $71.4400
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Subtotal (Total Children Is Unduplicated) 714 1330 6313.306010 $358632.3000 $56.8100
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Total 1360 6370.393311 $359340.1500 $56.4100
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Number of Children (Unduplicated) With at Least One Authorization 734