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: 10-01-21 and 12-31-21 Date of Report: 02-04-22 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 454 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 3 3 1.544444 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 3 3 1.544444 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 3 3 3.000000 $150.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 3 3 3.000000 $150.0000 $50.0000
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 2.800000 $140.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 1 1.500000 $75.0000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 146 169 388.097618 $19404.8800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 95 112 237.966667 $11898.3400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 37 38 79.233336 $3961.6800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 114 119 237.533335 $11876.6800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 5.133333 $128.3300 $25.0000
INTR -T1013 INTERPRETER 5 5 36.580952 $1829.0500 $50.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 2.000000 $456.0000 $228.0000
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Subtotal (Total Children Is Unduplicated) 187 448 990.845241 $49769.9500 $50.2300
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Total 454 995.389685 $49919.9500 $50.1500
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Number of Children (Unduplicated) With at Least One Authorization 191