Summary Report for FSPSAs Initiated During the Report Period Center: 53
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 259 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 19 19 38.277778 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 19 19 38.277778 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 8 9 7.316666 $354.8600 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.000000 $22.0700 $22.0700
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Subtotal (Total Children Is Unduplicated) 9 10 8.316666 $376.9300 $45.3200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 6 4.683333 $23416.5000 $4999.9600
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 5 6 5.428571 $271.4300 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 1 1 1.000000 $50.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 0.400000 $10.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 8 8 17.494445 $874.7300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 27 30 29.356349 $1467.8200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 23 23 26.830158 $1341.5100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 39 42 31.939682 $1596.9900 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 2.133333 $106.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 3.900000 $97.5000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 8 8 64.780953 $3239.0500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 2 16.190476 $809.5200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 68 95 288.780167 $3465.3600 $12.0000
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 9.714286 $699.0400 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 6.571429 $472.8800 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 2 2 13.214286 $950.9000 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 4.600000 $331.0200 $71.9600
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Subtotal (Total Children Is Unduplicated) 144 230 527.017468 $39200.8900 $74.3800
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Total 259 573.611912 $39577.8100 $69.0000
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Number of Children (Unduplicated) With at Least One Authorization 165