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: 10-01-23 and 12-31-23 Date of Report: 01-14-24 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1309 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 16 16 37.238097 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 16 16 37.238097 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 8.428572 $421.4300 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 10 10 57.580952 $2879.0600 $50.0000
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 7 7 53.285715 $2739.4200 $51.4100
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Subtotal (Total Children Is Unduplicated) 19 19 119.295239 $6039.9000 $50.6300
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 124 181 216.026650 $10801.3500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 85 120 120.335490 $3008.3900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 69 71 81.403969 $4070.2000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 37 38 39.388095 $1969.4000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 17 17 29.438096 $1471.9100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 41 41 42.411112 $2120.5600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 596 659 4729.933381 $236496.5200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 42 47 285.369051 $20535.1300 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 29 32 243.342858 $17510.9600 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 64 68 518.278575 $37295.3300 $71.9600
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Subtotal (Total Children Is Unduplicated) 645 1274 6305.927277 $335279.7200 $53.1700
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Total 1309 6462.460613 $341319.6200 $52.8200
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Number of Children (Unduplicated) With at Least One Authorization 661