Summary Report for FSPSAs Ending During the Report Period Center: 09
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 1345 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 42 43 67.155556 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 42 43 67.155556 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 4 4 6.142857 $307.1400 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 4 4 6.142857 $307.1400 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 97 152 215.983641 $10799.1900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 98 147 152.312181 $3807.8000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 65 68 68.405555 $3420.2800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 7 7 7.000000 $175.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 41 41 46.323810 $2316.1900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 26 27 41.640476 $2082.0200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 51 52 50.861112 $2543.0600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 4.233333 $105.8300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 464 527 3257.408739 $162870.4500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 59 61 321.395241 $22960.4800 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 71 79 509.290478 $36383.7200 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 2 2 8.571428 $612.3500 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 115 130 862.428574 $61611.9100 $71.4400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 599 1298 5545.854568 $309688.2700 $55.8400
-------------------------------------------------------------------------------------------------------------------------------------
Total 1345 5619.152981 $309995.4100 $55.1700
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 636