Summary Report for FSPSAs Initiated During the Report Period Center: 53
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: 07-01-22 and 09-30-22 Date of Report: 10-19-22 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 408 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 9 9 8.566667 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 9 9 8.566667 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 2 2 1.038889 $50.3900 $48.5000
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Subtotal (Total Children Is Unduplicated) 2 2 1.038889 $50.3900 $48.5000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 3 3 1.622222 $81.1100 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4 4 6.469047 $323.4500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 34 34 32.568256 $1628.4200 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 2 2 1.733333 $86.6700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 18 18 18.227778 $911.3900 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 1 1 1.000000 $50.0000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 15 15 16.499998 $824.9900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 2 2 2.000000 $100.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 2.200000 $55.0000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 7 8 45.842856 $2292.1500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 3 3 12.571429 $628.5700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 252 305 1336.623017 $13366.2400 $10.0000
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 12.428571 $894.3600 $71.9600
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Subtotal (Total Children Is Unduplicated) 256 397 1489.786507 $21242.3400 $14.2600
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Total 408 1499.392063 $21292.7300 $14.2000
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Number of Children (Unduplicated) With at Least One Authorization 265