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 279 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 12 12 22.947619 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 12 12 22.947619 $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 3 3 8.638095 $431.9000 $50.0000
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Subtotal (Total Children Is Unduplicated) 4 4 14.638095 $731.9000 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 54 90 141.250000 $7062.5000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 16 22 23.000000 $575.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 31 32 31.830953 $1591.5500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.002740 $0.0700 $24.6400
CONOF -CONOF CONSULT, OT, FACE TO FACE 21 21 19.666667 $983.3400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 13 13 10.400000 $520.0000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.450000 $11.2500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 20 20 24.967461 $1248.3800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 30 33 177.585715 $8879.2800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 9 9 47.214286 $3397.5300 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 8 8 55.857143 $4019.4800 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 13 13 63.571427 $4574.6000 $71.9600
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Subtotal (Total Children Is Unduplicated) 139 263 595.796392 $32862.9600 $55.1600
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Total 279 633.382106 $33594.8600 $53.0400
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Number of Children (Unduplicated) With at Least One Authorization 155