Summary Report for FSPSAs Ending During the Report Period Center: 52
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 471 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
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 2 2 2.000000 $100.0000 $50.0000
SCREEN-T1023 SCREENING 2 2 2.000000 $100.0000 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 4 4 4.000000 $200.0000 $50.0000
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.700000 $35.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 10 11 14.616667 $730.8400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 0.750000 $18.7500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 141 189 413.300003 $20665.0200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 88 105 262.366665 $13118.3300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 38 40 115.566664 $5778.3200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 94 104 204.916664 $10245.8200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6 6 29.142858 $1457.1400 $50.0000
INTR -T1013 INTERPRETER 7 7 61.642859 $3082.1400 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 3 18.428572 $1316.5300 $71.4400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 180 467 1121.430952 $56447.8700 $50.3400
-------------------------------------------------------------------------------------------------------------------------------------
Total 471 1125.430952 $56647.8700 $50.3300
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 181