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
Eligibility Filter: Program Patients
With the filters selected there were 437 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 32 32 72.019049 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 32 32 72.019049 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 10 10 53.180953 $2659.0600 $50.0000
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 2 2 12.285715 $631.6100 $51.4100
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Subtotal (Total Children Is Unduplicated) 12 12 65.466668 $3290.6600 $50.2600
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 87 131 201.049772 $10052.4900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 12 14 13.000000 $325.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 57 58 74.270636 $3713.5300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 30 30 34.993651 $1749.6800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 10 10 22.838096 $1141.9100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 38 38 41.794444 $2089.7200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 77 82 466.295246 $23314.7300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 8 8 14.714287 $1058.8300 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 8 8 77.142859 $5551.2000 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 13 14 105.357146 $7581.4900 $71.9600
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Subtotal (Total Children Is Unduplicated) 203 393 1051.456137 $56578.5700 $53.8100
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Total 437 1188.941854 $59869.2300 $50.3600
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Number of Children (Unduplicated) With at Least One Authorization 241