Summary Report for FSPSAs Ending During the Report Period Center: 09
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 283 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 17 17 32.206348 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 17 17 32.206348 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 11.857143 $592.8600 $50.0000
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Subtotal (Total Children Is Unduplicated) 1 1 11.857143 $592.8600 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 53 81 112.027778 $5601.3900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 13 17 16.500000 $412.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 40 41 34.276189 $1713.8100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.227778 $5.7000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 27 28 25.028571 $1251.4300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 11 11 7.088889 $354.4500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 28 29 24.094444 $1204.7200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 29 33 198.309522 $9915.4700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 7 9 57.028572 $4103.7700 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 3 3 25.714286 $1850.3900 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 11 12 59.416668 $4275.6100 $71.9600
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Subtotal (Total Children Is Unduplicated) 139 265 559.712697 $30689.2300 $54.8300
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Total 283 603.776188 $31282.0800 $51.8100
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Number of Children (Unduplicated) With at Least One Authorization 156