Summary Report for FSPSAs Ending During the Report Period Center: 09
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 1207 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 14 14 24.914285 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 14 14 24.914285 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 6.000000 $300.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 9 9 28.800000 $1440.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 10 10 34.800000 $1740.0000 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 102 154 202.615778 $10130.7900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 63 87 86.788891 $2169.7300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 40 43 38.858731 $1942.9400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 3 0.327702 $8.1900 $24.9900
CONOF -CONOF CONSULT, OT, FACE TO FACE 27 27 23.605556 $1180.2800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 18 19 15.783333 $789.1700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.450000 $11.2500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 35 36 37.384128 $1869.2100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 507 560 3654.428571 $182721.3800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 70 76 382.845237 $27549.5300 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 50 52 400.561908 $28824.4400 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 110 124 803.188093 $57797.4000 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 6.142857 $442.0400 $71.9600
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Subtotal (Total Children Is Unduplicated) 610 1183 5652.980785 $315436.3400 $55.8000
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Total 1207 5712.695070 $317176.3300 $55.5200
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Number of Children (Unduplicated) With at Least One Authorization 621