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: 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 1259 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 35.020636 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 19 19 35.020636 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 3 4 10.190477 $509.5300 $50.0000
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 4 5 11.190477 $560.5800 $50.0900
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 77 124 177.961395 $8898.0700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 150 215 217.318381 $5432.9700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 37 40 31.702381 $1585.1200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 1.472222 $36.8100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 26 26 49.577777 $2478.8900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 23 25 18.316668 $915.8400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 31 32 33.729366 $1686.4700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 6 4.544444 $113.6100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 432 469 2987.904758 $149395.2600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 61 66 360.557143 $25758.2200 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 5.571429 $398.0200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 67 75 442.730161 $31628.6500 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 140 150 917.045237 $65513.7600 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 4 4 45.857143 $3276.0300 $71.4400
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Subtotal (Total Children Is Unduplicated) 570 1235 5294.288505 $297117.7000 $56.1200
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Total 1259 5340.499618 $297678.2700 $55.7400
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Number of Children (Unduplicated) With at Least One Authorization 589