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: 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 249 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 18 18 19.226984 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 18 18 19.226984 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 4 4 13.457142 $672.8600 $50.0000
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Subtotal (Total Children Is Unduplicated) 4 4 13.457142 $672.8600 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 56 88 130.277778 $6513.8900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 11 14 10.255480 $256.3900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 32 32 26.133334 $1306.6700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 18 18 15.338888 $766.9400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 10 10 6.827778 $341.3900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 24 24 19.511111 $975.5600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 19 19 123.714287 $6185.7200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 6 9 30.357142 $2184.5000 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 2 3 11.142856 $801.8400 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 9 10 45.892858 $3302.4600 $71.9600
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Subtotal (Total Children Is Unduplicated) 124 227 419.451512 $22635.3600 $53.9600
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Total 249 452.135638 $23308.2200 $51.5500
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Number of Children (Unduplicated) With at Least One Authorization 145