Summary Report for FSPSAs Initiated During the Report Period Center: 06
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: 10-01-23 and 12-31-23 Date of Report: 01-14-24 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 1451 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 36 36 57.213492 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 36 36 57.213492 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT COS Exit 2 2 3.000000 $150.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 2 2 3.000000 $150.0000 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 166 180 126.778210 $6338.9400 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 61 65 65.711906 $3285.6100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 126 128 61.272523 $1531.8100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 10 10 14.700000 $735.0000 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 4 5 10.647620 $532.3900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.266667 $31.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 6 6 14.964287 $748.2200 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 2 2 2.700000 $135.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.266667 $31.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 4 4 12.916666 $645.8300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2 2 3.533333 $176.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.116667 $27.9200 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 43.428571 $1085.7200 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 3.857143 $192.8600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 191 232 1443.661923 $72182.9900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 9 9 24.999999 $1250.0000 $50.0000
INTR -T1013 INTERPRETER 48 67 263.457142 $13172.8700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 558 681 4330.195290 $51962.2800 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 9.000000 $647.6400 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 7.000000 $503.7200 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 2 2 5.828571 $335.7300 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 2 2 11.250000 $809.5500 $71.9600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 1.857143 $106.8900 $57.5600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 7 8 38.357142 $2760.1800 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 8.857143 $637.3600 $71.9600
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Subtotal (Total Children Is Unduplicated) 769 1413 6508.624613 $159868.4800 $24.5600
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Total 1451 6568.838105 $160018.4800 $24.3600
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Number of Children (Unduplicated) With at Least One Authorization 797