Summary Report for FSPSAs Initiated During the Report Period Center: 52
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 494 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
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 1.000000 $50.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 1 1 1.000000 $50.0000 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 3 3 3.000000 $151.0500 $50.3500
EI Services, Class # 03
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 2.166667 $108.3400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 3.000000 $150.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 15 19 22.000000 $1100.0000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 158 185 447.033336 $22351.6800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 87 93 236.766667 $11838.3400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 44 46 111.933333 $5596.6700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 130 133 287.308329 $14365.4000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6 7 29.338096 $1466.9100 $50.0000
INTR -T1013 INTERPRETER 5 5 53.247620 $2662.3800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 5.533333 $395.3000 $71.4400
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Subtotal (Total Children Is Unduplicated) 196 491 1198.327381 $60034.9900 $50.1000
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Total 494 1201.327381 $60186.0400 $50.1000
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Number of Children (Unduplicated) With at Least One Authorization 197