Summary Report for FSPSAs Initiated During the Report Period Center: 07
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
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 848 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 16 16 8.834127 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 16 16 8.834127 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.111111 $2.4500 $22.0700
EXIT -EXIT EXIT ASSESSMENT 4 4 4.000000 $200.0000 $50.0000
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 0.327778 $16.8500 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.327778 $16.8500 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.4100 $51.4100
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Subtotal (Total Children Is Unduplicated) 8 9 6.766667 $338.9800 $50.1000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 128 173 119.254761 $5962.8300 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 1 1 1.000000 $50.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 5 11.775001 $294.3800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 255 280 600.582322 $30029.1200 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 2 5.333334 $266.6700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 120 124 210.457147 $10522.8800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 2.733333 $68.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 58 61 110.414286 $5520.7200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.533333 $13.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 121 140 229.466666 $11473.3300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 2.466667 $61.6700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 20 20 144.957141 $7247.8800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 9 10 62.776192 $3138.8100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2 2 2.714285 $27.1400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 8.428571 $606.5200 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 1 1 8.428571 $606.5200 $71.9600
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Subtotal (Total Children Is Unduplicated) 340 823 1521.321610 $75890.1100 $49.8800
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Total 848 1536.922404 $76229.0900 $49.6000
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Number of Children (Unduplicated) With at Least One Authorization 359