Summary Report for FSPSAs Ending During the Report Period Center: 53
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 474 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 6 6 10.411111 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 6 6 10.411111 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 6 7 3.022222 $146.5800 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 1.000000 $19.5100 $19.5100
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Subtotal (Total Children Is Unduplicated) 7 8 4.022222 $166.0900 $41.2900
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 6 8 5.827778 $291.3900 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 2 2 1.250000 $62.5000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2 2 0.291667 $14.5900 $50.0100
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 1.733333 $86.6700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 36 36 35.388095 $1769.4000 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 3 3 5.000000 $250.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.916667 $22.9200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 20 22 22.316667 $1115.8400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 21 22 24.849206 $1242.4600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 2.866667 $71.6700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 8 8 40.876192 $2043.8100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 4 4 15.171428 $758.5800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 267 347 1445.959531 $14459.5900 $10.0000
PHY -97110 PT SESSION BY LICENSED PT 1 1 0.466667 $33.5800 $71.9700
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 0.142857 $10.2800 $71.9800
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Subtotal (Total Children Is Unduplicated) 272 460 1603.056755 $22233.2500 $13.8700
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Total 474 1617.490088 $22399.3400 $13.8500
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Number of Children (Unduplicated) With at Least One Authorization 278