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: 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 358 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 3 3 0.622222 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 3 3 0.622222 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EVAL -96111 DEVELOPMENTAL EVALUATION 2 2 2.000000 $100.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 2 2 2.000000 $100.0000 $50.0000
EI Services, Class # 03
CONIF -CONIF CONSULT, ITDS FACE TO FACE 130 151 340.216669 $17010.8500 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 2.166667 $108.3400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 77 84 195.466671 $9773.3600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 38 45 121.766666 $6088.3300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 65 65 135.166670 $6758.3500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 5.833333 $145.8300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 3 3 19.038096 $951.9100 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 0.750000 $53.9700 $71.9600
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Subtotal (Total Children Is Unduplicated) 159 353 820.404772 $40890.9200 $49.8400
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Total 358 823.026994 $40990.9200 $49.8100
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Number of Children (Unduplicated) With at Least One Authorization 162