Summary Report for FSPSAs Ending During the Report Period Center: 06
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 820 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 43 45 53.277780 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 43 45 53.277780 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 19 19 38.000000 $1900.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 19 19 38.000000 $1900.0000 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 78 84 19.952671 $997.7400 $50.0100
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 3 3 1.011112 $50.5600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 61 63 19.911441 $497.8100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4 4 6.233334 $311.6700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.366667 $34.1700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2 2 2.950000 $147.5000 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 1 1 1.133333 $56.6700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 1.433334 $71.6700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2 2 1.150000 $57.5000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.366667 $34.1700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 4 5 28.428571 $1421.4300 $50.0000
INTR -T1013 INTERPRETER 17 18 144.499999 $7225.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 495 565 3562.010333 $35620.1100 $10.0000
PHY -97110 PT SESSION BY LICENSED PT 1 1 0.928571 $66.3400 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 1.214286 $86.7500 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 3 7.428571 $530.7000 $71.4400
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Subtotal (Total Children Is Unduplicated) 513 756 3801.018890 $47209.7600 $12.4200
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Total 820 3892.296670 $49109.7600 $12.6200
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Number of Children (Unduplicated) With at Least One Authorization 557