Summary Report for FSPSAs Initiated During the Report Period Center: 07
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 858 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 21 21 12.784921 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 21 21 12.784921 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 20 20 33.750000 $1687.5000 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.5500 $44.5500
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Subtotal (Total Children Is Unduplicated) 22 22 35.750000 $1783.1000 $49.8800
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 151 195 118.873573 $5943.7800 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 2 3 3.000000 $150.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 6 7.488095 $187.2000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 259 292 629.597610 $31479.8700 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 2.800000 $140.0000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 3 2.066666 $51.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 132 135 223.669045 $11183.4400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 39 41 66.219046 $3310.9500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 121 127 231.045230 $11552.2300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 2.400000 $60.0000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 6 6 29.323809 $1466.2000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 2 2 16.857142 $842.8600 $50.0000
PHY -97110 PT SESSION BY LICENSED PT 1 1 7.428571 $530.7000 $71.4400
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Subtotal (Total Children Is Unduplicated) 344 815 1341.768787 $66948.8700 $49.9000
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Total 858 1390.303708 $68731.9700 $49.4400
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Number of Children (Unduplicated) With at Least One Authorization 376