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
Eligibility Filter: Program Patients
With the filters selected there were 563 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 19 19 31.676189 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 19 19 31.676189 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 2.433333 $121.6700 $50.0000
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Subtotal (Total Children Is Unduplicated) 1 1 2.433333 $121.6700 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 91 146 230.500000 $11525.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 22 28 29.000000 $725.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 54 56 62.449206 $3122.4700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 3 0.447185 $11.1800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 43 43 49.607143 $2480.3600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 18 18 13.700001 $685.0100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 55 55 49.450000 $2472.5000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.000000 $25.0000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 9.571429 $478.5700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 108 121 862.157149 $43107.8300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 18 19 162.423810 $11688.0200 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 13 13 82.834524 $5960.7800 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 37 39 289.892864 $20860.6600 $71.9600
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Subtotal (Total Children Is Unduplicated) 287 543 1843.033311 $103142.3600 $55.9600
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Total 563 1877.142833 $103264.0200 $55.0100
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Number of Children (Unduplicated) With at Least One Authorization 305