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
Eligibility Filter: Program Patients
With the filters selected there were 607 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 22 22 33.773015 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 22 22 33.773015 $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 95 153 239.500000 $11975.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 22 29 30.000000 $750.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 54 56 55.053175 $2752.6600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.002740 $0.0700 $24.6400
CONOF -CONOF CONSULT, OT, FACE TO FACE 39 42 40.200000 $2010.0000 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 1 1 1.000000 $50.0000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 25 25 21.633333 $1081.6700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.450000 $11.2500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 39 39 40.989682 $2049.4800 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 1 1 1.000000 $50.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 150 159 953.114286 $47655.7100 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 15 15 107.214286 $7715.1300 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 19 19 126.000002 $9066.9500 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 40 40 242.357144 $17440.0200 $71.9600
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Subtotal (Total Children Is Unduplicated) 321 581 1858.514648 $102607.9400 $55.2100
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Total 607 1906.925758 $103339.8400 $54.1900
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Number of Children (Unduplicated) With at Least One Authorization 346