Summary Report for FSPSAs Initiated During the Report Period Center: 04
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: 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 584 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 42 43 32.147619 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 42 43 32.147619 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
PSTH -97163TL PT EVAL HIGH COMPLEXITY 2 2 0.500000 $25.7100 $51.4100
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Subtotal (Total Children Is Unduplicated) 2 2 0.500000 $25.7100 $51.4100
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 22 55 24.115870 $1205.7800 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 6 6 10.226985 $511.3500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.033333 $25.8300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 9 9 5.078570 $253.9300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.033333 $25.8300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 0.355556 $17.7800 $50.0100
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4 4 0.411110 $20.5500 $49.9900
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 10 10 64.857144 $3242.8600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 418 446 3262.617437 $39151.4500 $12.0000
PHY -97110TL PT SESSION BY LICENSED PT 4 4 12.500000 $899.5100 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 1.642857 $118.2200 $71.9600
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Subtotal (Total Children Is Unduplicated) 447 539 3383.872195 $45473.0800 $13.4400
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Total 584 3416.519814 $45498.7800 $13.3200
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Number of Children (Unduplicated) With at Least One Authorization 483