Summary Report for FSPSAs Initiated During the Report Period Center: 06
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: 01-01-22 and 03-31-22 Date of Report: 04-16-22 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 873 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 35 35 26.061905 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 35 35 26.061905 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 3 3 6.000000 $300.0000 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 3 3 6.000000 $300.0000 $50.0000
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.644444 $32.2200 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 90 92 21.397706 $1069.9700 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 3 3 1.750000 $87.5000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 72 72 24.228582 $605.7400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5 5 8.933334 $446.6700 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 0.700000 $35.0000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 3 4.366667 $109.1700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3 3 5.000000 $250.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.266667 $6.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4 4 7.666666 $383.3300 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 1 1 0.700000 $35.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 4.100000 $102.5000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 3 3 15.428572 $771.4300 $50.0000
INTR -T1013 INTERPRETER 42 43 169.071428 $8453.5700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 518 595 3355.638054 $33556.4000 $10.0000
PHY -97110 PT SESSION BY LICENSED PT 2 2 7.428571 $530.7000 $71.4400
SENS -V5264 EARMOLD 1 1 0.644444 $11.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 3 10.428571 $745.0200 $71.4400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 582 835 3638.393706 $47232.4700 $12.9800
-------------------------------------------------------------------------------------------------------------------------------------
Total 873 3670.455611 $47532.4700 $12.9500
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 610