Summary Report for FSPSAs Ending During the Report Period Center: 52
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
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 364 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 1 1 0.466667 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 0.466667 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
SCREEN-T1023 SCREENING 2 2 2.000000 $100.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 2 2 2.000000 $100.0000 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 1 1.000000 $50.0000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 118 149 370.185708 $18509.2600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 77 84 229.119041 $11455.9200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 45 52 151.099998 $7554.9900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 65 66 180.583327 $9029.1400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 4.390476 $109.7600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 3 3 4.133333 $206.6700 $50.0000
INTR -T1013 INTERPRETER 1 1 0.700000 $35.0000 $50.0000
PHY -97110 PT SESSION BY LICENSED PT 1 1 2.035714 $146.4900 $71.9600
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Subtotal (Total Children Is Unduplicated) 152 361 943.247597 $47097.2100 $49.9300
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Total 364 945.714264 $47197.2100 $49.9100
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Number of Children (Unduplicated) With at Least One Authorization 154