Summary Report for FSPSAs Ending During the Report Period Center: 06
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: 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 896 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 37 37 51.993651 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 37 37 51.993651 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 3 3 12.857143 $642.8600 $50.0000
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Subtotal (Total Children Is Unduplicated) 3 3 12.857143 $642.8600 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 135 143 75.169899 $3758.5500 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 16 16 7.590874 $379.5500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 80 82 39.244674 $981.1200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 9 9 5.549999 $277.5000 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 0.966667 $48.3400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 5 3.209524 $80.2400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3 3 2.500000 $125.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 3 0.750000 $18.7500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 3 3 1.550000 $77.5000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 5 5 3.033333 $151.6700 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 1 1 0.966667 $48.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 2.216667 $55.4200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 9 9 43.428572 $2171.4300 $50.0000
INTR -T1013 INTERPRETER 23 23 100.035714 $5001.7900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 473 544 3121.304769 $31213.0300 $10.0000
PHY -97110 PT SESSION BY LICENSED PT 3 4 28.357143 $2040.5800 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 3 35.214285 $2534.0200 $71.9600
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Subtotal (Total Children Is Unduplicated) 525 856 3471.088787 $48962.7800 $14.1100
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Total 896 3535.939581 $49605.6400 $14.0300
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Number of Children (Unduplicated) With at Least One Authorization 560