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: 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 462 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 2 2 1.688888 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 2 1.688888 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 2 2 2.000000 $100.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 2 2 2.000000 $100.0000 $50.0000
EI Services, Class # 03
CONIF -CONIF CONSULT, ITDS FACE TO FACE 166 189 430.033338 $21501.6900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.750000 $18.7500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 85 96 234.433334 $11721.6700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 46 51 134.233331 $6711.6600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 116 120 268.666671 $13433.3600 $50.0000
INTR -T1013 INTERPRETER 1 1 0.533333 $26.6700 $50.0000
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Subtotal (Total Children Is Unduplicated) 203 458 1068.650007 $53413.7900 $49.9800
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Total 462 1072.338895 $53513.7900 $49.9000
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Number of Children (Unduplicated) With at Least One Authorization 207