Summary Report for FSPSAs Ending During the Report Period Center: 09
This report shows the total number of units/fees for FSPSAs ending during the report period.
(i.e., end 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 ending 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 264 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 18 28.620634 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 16 18 28.620634 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 2.400000 $120.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 1 1 2.400000 $120.0000 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 56 89 131.277778 $6563.8900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 10 13 9.505480 $237.6400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 33 33 37.887975 $1894.4000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.488889 $12.2200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 24 24 22.350000 $1117.5000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 13 13 14.794325 $739.7200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 21 21 48.652382 $2432.6200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 21 23 124.142857 $6207.1500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 8 10 33.607144 $2418.3600 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 6 6 42.607142 $3066.0100 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 11 11 97.285714 $7000.6700 $71.9600
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Subtotal (Total Children Is Unduplicated) 135 245 563.599686 $31715.1800 $56.2700
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Total 264 594.620320 $31835.1800 $53.5400
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Number of Children (Unduplicated) With at Least One Authorization 149