Summary Report for FSPSAs Initiated During the Report Period Center: 09
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
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1198 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 13 13 19.585713 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 13 13 19.585713 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 3.714286 $185.7200 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 7 7 39.942857 $1997.1500 $50.0000
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Subtotal (Total Children Is Unduplicated) 8 8 43.657143 $2182.8600 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 97 146 194.593556 $9729.6800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 63 85 98.429368 $2460.7400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 46 50 44.206349 $2210.3200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 4 0.449925 $11.2500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 33 34 38.018254 $1900.9100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 17 19 13.588889 $679.4500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 43 48 39.583333 $1979.1700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 1.544445 $38.6100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 510 559 3711.619060 $185580.8300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 73 75 540.930960 $38925.3700 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 9.714286 $699.0400 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 35 38 287.895240 $20716.9400 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 104 115 775.873816 $55831.8500 $71.9600
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Subtotal (Total Children Is Unduplicated) 602 1177 5756.447481 $320764.1400 $55.7200
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Total 1198 5819.690337 $322947.0000 $55.4900
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Number of Children (Unduplicated) With at Least One Authorization 613