Summary Report for FSPSAs Ending During the Report Period Center: 04
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: 04-01-23 and 06-30-23 Date of Report: 07-25-23 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 669 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 38 39 25.657141 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 38 39 25.657141 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
OCTH -97167TL OT EVAL HIGH COMPLEXITY 2 2 0.588889 $30.2800 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 1 1 0.372222 $19.1300 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 0.205556 $10.5700 $51.4200
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 0.372222 $19.1300 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 0.172222 $8.8500 $51.4000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.133333 $6.8500 $51.4000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 3 7 1.844444 $94.8200 $51.4100
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 24 60 15.611897 $780.5600 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3 3 1.122222 $56.1100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 3 3.111110 $77.7800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 8 8 1.377777 $68.8900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 2 2.366666 $59.1700 $25.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.744444 $18.6100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 6 6 2.879365 $143.9700 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 3.428571 $85.7200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 8 8 66.142856 $3307.1500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 12 13 74.999999 $3750.0100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 471 518 3272.057154 $39264.6800 $12.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 507 623 3443.842061 $47612.6200 $13.8300
-------------------------------------------------------------------------------------------------------------------------------------
Total 669 3471.343646 $47707.4400 $13.7400
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 543