Summary Report for FSPSAs Initiated During the Report Period Center: 04
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: 10-01-22 and 12-31-22 Date of Report: 01-23-23 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 599 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 31 31 18.553969 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 31 31 18.553969 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 0.061111 $2.9600 $48.4900
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.161111 $9.0400 $56.1000
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 2 0.361111 $18.5600 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 0.188889 $9.7100 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 4.142857 $212.9900 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 3 0.877777 $45.1200 $51.4100
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Subtotal (Total Children Is Unduplicated) 7 9 5.792856 $298.3900 $51.5100
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 31 82 20.853175 $1042.6600 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1 1 0.833333 $41.6700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 1.744444 $43.6100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 7 7 6.716666 $335.8300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.700000 $42.5000 $25.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.044444 $1.1100 $24.9800
CONSF -CONSF CONSULT, SLP, FACE TO FACE 5 5 5.471429 $273.5700 $50.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 6.285714 $157.1400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 8.571429 $214.2900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 12 12 117.857143 $5892.8600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 4 4 22.000001 $1100.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 420 439 3349.153180 $33491.5100 $10.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 3 18.142857 $1305.5600 $71.9600
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Subtotal (Total Children Is Unduplicated) 460 559 3559.373815 $43942.3000 $12.3500
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Total 599 3583.720640 $44240.6900 $12.3400
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Number of Children (Unduplicated) With at Least One Authorization 492