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: 04-01-20 and 06-30-20 Date of Report: 07-20-20 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 274 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 19 19 43.558729 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 19 19 43.558729 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 3 9.571428 $478.5700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 3 3 1.466667 $73.3400 $50.0000
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Subtotal (Total Children Is Unduplicated) 6 6 11.038095 $551.9100 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 48 83 113.097012 $5654.8600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 42 52 54.052245 $1351.3100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 20 20 20.722222 $1036.1100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.000000 $25.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 17 17 18.422223 $921.1200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 23 23 23.750002 $1187.5100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 26 27 37.592857 $1879.6500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 16 16 83.571427 $4178.5800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 12.480953 $891.6400 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 3 3 14.142857 $1010.3700 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 5 5 24.571428 $1755.3800 $71.4400
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Subtotal (Total Children Is Unduplicated) 129 249 403.403226 $19891.5100 $49.3100
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Total 274 458.000050 $20443.4200 $44.6400
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Number of Children (Unduplicated) With at Least One Authorization 154