Summary Report for FSPSAs Initiated During the Report Period Center: 06
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: 01-01-23 and 03-31-23 Date of Report: 04-20-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 1842 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 42 42 46.974604 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 42 42 46.974604 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 6 6 12.000000 $600.0000 $50.0000
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 2 2 0.455555 $64.7900 $142.2100
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Subtotal (Total Children Is Unduplicated) 8 8 12.455555 $664.7900 $53.3700
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 276 281 152.622531 $7631.2100 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 19 19 9.766668 $488.3400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 156 161 77.765586 $1944.1500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 16 17 23.922221 $1196.1100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 4 4 3.216667 $160.8400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 17 19 27.002382 $675.0600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 9 9 14.966666 $748.3300 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 3 3 3.166667 $158.3400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 9 9 12.733334 $318.3400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 7 7 3.016666 $150.8300 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 2 2 2.100000 $105.0000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 6 6 4.092858 $102.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2 3 1.833334 $91.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 10.485714 $262.1400 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 2 2 22.857143 $571.4300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 240 259 1428.809523 $71440.5500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 4 4 25.142858 $1257.1500 $50.0000
INTR -T1013 INTERPRETER 24 32 168.178571 $8408.9300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 801 921 5247.490473 $52474.9600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 5 5 6.952381 $500.3000 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 1 1 5.142857 $296.2300 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 4 5 26.178572 $1883.8100 $71.9600
PHY -97110HM PT SESSION BY PT ASST 1 1 1.714286 $98.6800 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 5.214286 $300.1400 $57.5600
SENS -V5264 EARMOLD 1 1 0.411111 $7.4500 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 11 15 67.392858 $4849.5900 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 0.285714 $20.5600 $71.9600
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 1.142857 $65.8300 $57.6000
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 18.928571 $264.2400 $13.9600
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Subtotal (Total Children Is Unduplicated) 984 1792 7372.533355 $156472.5100 $21.2200
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Total 1842 7431.963514 $157137.2900 $21.1400
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Number of Children (Unduplicated) With at Least One Authorization 1020