Summary Report for FSPSAs Initiated During the Report Period Center: 06
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
Eligibility Filter: Program Patients
With the filters selected there were 1662 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 40 40 64.182538 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 40 40 64.182538 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 3 3 11.123810 $556.1900 $50.0000
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 2 2 1.722222 $244.9500 $142.2300
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Subtotal (Total Children Is Unduplicated) 5 5 12.846032 $801.1400 $62.3600
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 242 253 135.185719 $6759.3700 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 32 32 15.923217 $796.1700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 127 132 81.943128 $2048.5800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 14 15 20.576787 $1028.8500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 17 20 23.812037 $595.3100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 5 5 6.758334 $337.9200 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 1 1 0.416667 $20.8400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 13 14 14.126338 $353.1600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 4 4 5.916667 $295.8400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 4 4 4.750000 $118.7500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2 2 3.116667 $155.8400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 5.735714 $143.3900 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 7 7 13.890476 $694.5300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 232 252 1692.780961 $84639.0100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 6 7 34.857143 $1742.8600 $50.0000
INTR -T1013 INTERPRETER 30 32 150.678571 $7533.9300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 685 803 5086.109552 $50861.0600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 4 7.133332 $513.3100 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 0.652778 $46.9800 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 1 1 2.928571 $168.6900 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 4.928571 $283.8900 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 2 3 30.999999 $2230.7600 $71.9600
SENS -V5264 EARMOLD 2 2 1.722222 $31.2200 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 13 15 87.857141 $6322.2000 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 0.214286 $15.4200 $71.9600
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Subtotal (Total Children Is Unduplicated) 861 1617 7433.014878 $167737.8500 $22.5700
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Total 1662 7510.043448 $168538.9800 $22.4400
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Number of Children (Unduplicated) With at Least One Authorization 893