Summary Report for FSPSAs Ending During the Report Period Center: 04
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 668 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 37 37 23.549209 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 37 37 23.549209 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 0.166667 $8.5100 $51.0600
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Subtotal (Total Children Is Unduplicated) 1 1 0.166667 $8.5100 $51.0600
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 26 81 45.786514 $2289.3500 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2 2 1.100000 $55.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2 2 1.100000 $55.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.261111 $6.5300 $25.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.488889 $12.2200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 19 20 97.857141 $4892.8600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 472 522 3261.227778 $32612.2700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 4.285714 $306.1700 $71.4400
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Subtotal (Total Children Is Unduplicated) 498 630 3412.107147 $40229.3900 $11.7900
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Total 668 3435.823023 $40237.9000 $11.7100
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Number of Children (Unduplicated) With at Least One Authorization 533