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: 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 1254 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 18 18 26.947619 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 18 18 26.947619 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 4 4 9.538096 $476.9100 $50.0000
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Subtotal (Total Children Is Unduplicated) 4 4 9.538096 $476.9100 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 117 163 188.264245 $9413.2400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 89 116 112.518801 $2812.9700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 36 37 34.188889 $1709.4500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.500000 $12.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 28 29 24.205555 $1210.2800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 13 14 16.599999 $830.0000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 28 29 39.257143 $1962.8600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 500 546 3433.599969 $171680.1200 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 3 9.714285 $485.7200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 77 83 516.361901 $36888.9200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 56 61 405.899998 $28997.5400 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 137 147 941.090467 $67231.5400 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 2 2 2.500000 $178.6000 $71.4400
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Subtotal (Total Children Is Unduplicated) 610 1232 5725.701252 $323438.7100 $56.4900
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Total 1254 5762.186967 $323915.6200 $56.2100
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Number of Children (Unduplicated) With at Least One Authorization 624