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
Eligibility Filter: Program Patients
With the filters selected there were 550 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 33 33 93.596829 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 33 33 93.596829 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 3 3 23.723810 $1186.2000 $50.0000
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Subtotal (Total Children Is Unduplicated) 3 3 23.723810 $1186.2000 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 95 149 222.527778 $11126.3900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 17 22 23.500000 $587.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 87 90 83.288887 $4164.4400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 48 50 48.016666 $2400.8300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 22 22 18.683333 $934.1700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 59 61 54.499998 $2724.9900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 79 86 549.438098 $27471.9100 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 11 12 90.714284 $6527.8200 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 6 8 49.552380 $3565.8000 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 13 14 95.773812 $6891.8900 $71.9600
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Subtotal (Total Children Is Unduplicated) 242 514 1235.995236 $66395.7200 $53.7200
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Total 550 1353.315875 $67581.9200 $49.9400
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Number of Children (Unduplicated) With at Least One Authorization 276