Summary Report for FSPSAs Initiated During the Report Period Center: 52
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 307 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 2 2 1.477778 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 2 1.477778 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
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Subtotal (Total Children Is Unduplicated) 1 1 1.000000 $51.4100 $51.4100
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 2 2 8.600000 $430.0000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 102 125 291.999999 $14600.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 66 78 228.790476 $11439.5200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 33 36 89.833336 $4491.6800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 57 58 133.266665 $6663.3300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 8.800000 $220.0000 $25.0000
INTR -T1013 INTERPRETER 1 1 1.000000 $50.0000 $50.0000
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 4.000000 $287.8400 $71.9600
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Subtotal (Total Children Is Unduplicated) 131 304 766.290476 $38182.3600 $49.8300
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Total 307 768.768254 $38233.7700 $49.7300
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Number of Children (Unduplicated) With at Least One Authorization 133