Summary Report for FSPSAs Initiated During the Report Period Center: 09
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 315 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 23 23 65.522225 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 23 23 65.522225 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 2 2 20.857143 $1042.8600 $50.0000
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Subtotal (Total Children Is Unduplicated) 2 2 20.857143 $1042.8600 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 58 89 127.527778 $6376.3900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 13 17 16.500000 $412.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 53 54 51.633333 $2581.6700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 30 32 31.783333 $1589.1700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 12 12 10.855556 $542.7800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 32 33 30.983333 $1549.1700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 27 30 183.395242 $9169.7600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 9 9 69.428571 $4996.0900 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 4 5 32.428571 $2333.5600 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 8 9 63.880955 $4596.8800 $71.9600
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Subtotal (Total Children Is Unduplicated) 144 290 618.416672 $34147.9500 $55.2200
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Total 315 704.796040 $35190.8100 $49.9300
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Number of Children (Unduplicated) With at Least One Authorization 167