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: 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 1333 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 25 25 63.561905 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 25 25 63.561905 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.633333 $81.6700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 4 4 18.371428 $918.5800 $50.0000
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Subtotal (Total Children Is Unduplicated) 5 5 20.004761 $1000.2400 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 113 161 188.264245 $9413.2400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 89 117 117.802592 $2945.0700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 56 56 70.668253 $3533.4100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.500000 $12.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 42 42 38.961110 $1948.0500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 2.000000 $50.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 21 21 22.719843 $1136.0000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 49 49 46.766666 $2338.3300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.277778 $31.9500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 483 550 3389.186520 $169459.1800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 2 29.142857 $1457.1500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 77 88 532.471432 $38039.7000 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 9.285714 $663.3700 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 60 67 444.985720 $31789.7600 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 16.857143 $1204.2700 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 126 143 829.547624 $59262.8300 $71.4400
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Subtotal (Total Children Is Unduplicated) 599 1303 5740.437497 $323284.7900 $56.3200
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Total 1333 5824.004163 $324285.0300 $55.6800
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Number of Children (Unduplicated) With at Least One Authorization 621