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: 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 518 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 38 39 69.866667 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 38 39 69.866667 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 6 7 26.714285 $1335.7200 $50.0000
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 2 2 20.142857 $1035.5500 $51.4100
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Subtotal (Total Children Is Unduplicated) 8 9 46.857142 $2371.2700 $50.6100
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 89 135 195.264058 $9763.2100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 13 15 14.000000 $350.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 79 82 70.800000 $3540.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 47 47 56.288096 $2814.4100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 22 22 17.272221 $863.6100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 43 45 47.682539 $2384.1200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 84 91 565.200002 $28259.9900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 12 12 76.714286 $5520.3700 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 7 7 41.214286 $2965.7800 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 14 14 84.250000 $6062.6400 $71.9600
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Subtotal (Total Children Is Unduplicated) 243 470 1168.685488 $62524.1100 $53.5000
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Total 518 1285.409297 $64895.3800 $50.4900
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Number of Children (Unduplicated) With at Least One Authorization 287