Summary Report for FSPSAs Initiated During the Report Period Center: 53
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 544 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 11 12 14.988889 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 11 12 14.988889 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 6 6 5.205556 $252.4700 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 0.544444 $12.0100 $22.0700
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 1.000000 $75.0000 $75.0000
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Subtotal (Total Children Is Unduplicated) 10 10 7.750000 $464.4900 $59.9300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 2.627778 $13139.0000 $5000.0400
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 4 5 4.250000 $212.5000 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 8 10 9.966667 $498.3400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3 3 1.711111 $85.5600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 34 37 43.555556 $2177.7800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.783333 $19.5800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 15 15 16.297619 $814.8800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 18 20 24.114285 $1205.7100 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 1.500000 $75.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 5.357143 $133.9300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6 6 47.257143 $2362.8600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 349 416 1859.765871 $22317.1900 $12.0000
PHY -97110 PT SESSION BY LICENSED PT 1 1 4.285714 $308.4000 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 2 7.142857 $514.0000 $71.9600
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Subtotal (Total Children Is Unduplicated) 353 522 2028.615077 $43864.7200 $21.6200
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Total 544 2051.353966 $44329.2100 $21.6100
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Number of Children (Unduplicated) With at Least One Authorization 362