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: 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 450 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 1 1 0.588889 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 0.588889 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 1 1 1.000000 $50.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 1 1 1.000000 $50.0000 $50.0000
EI Services, Class # 03
CONIF -CONIF CONSULT, ITDS FACE TO FACE 155 190 376.166664 $18808.3200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.750000 $18.7500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 86 98 242.199998 $12109.9900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 47 49 106.499999 $5325.0000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 102 108 207.066662 $10353.3100 $50.0000
INTR -T1013 INTERPRETER 2 2 8.076190 $403.8100 $50.0000
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Subtotal (Total Children Is Unduplicated) 184 448 940.759513 $47019.1800 $49.9800
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Total 450 942.348402 $47069.1800 $49.9500
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Number of Children (Unduplicated) With at Least One Authorization 186