Summary Report for FSPSAs Initiated During the Report Period Center: 09
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: 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 1337 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 52.500004 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 35 35 52.500004 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 4 4 11.652380 $582.6200 $50.0000
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Subtotal (Total Children Is Unduplicated) 4 4 11.652380 $582.6200 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 97 152 220.061419 $11003.0800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 94 142 144.608071 $3615.2000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 71 77 85.834124 $4291.7000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 7 7 5.038889 $125.9700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 51 53 47.883334 $2394.1700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 26 28 27.522222 $1376.1100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 49 50 47.038889 $2351.9500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 2.822222 $70.5600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 478 532 3836.699206 $191835.0400 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 57 60 361.409520 $25819.1600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 62 68 508.714283 $36342.5800 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 25.142857 $1796.2100 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 112 124 913.857139 $65286.0200 $71.4400
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Subtotal (Total Children Is Unduplicated) 589 1298 6226.632175 $346307.7300 $55.6200
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Total 1337 6290.784559 $346890.3400 $55.1400
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Number of Children (Unduplicated) With at Least One Authorization 616