Summary Report for FSPSAs Ending During the Report Period Center: 53
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: 01-01-24 and 03-31-24 Date of Report: 04-04-25 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 185 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 12 14 14.516666 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 12 14 14.516666 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 6 7 6.161111 $298.8100 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 1.116667 $27.1100 $24.2800
EXIT -EXIT COS Exit 2 2 3.000000 $150.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 10 11 10.277778 $475.9300 $46.3100
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 11 14 7.642857 $382.1500 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 5 5 3.285714 $164.2900 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3 3 3.607143 $180.3600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 16 16 19.001588 $950.0800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 14 16 1.950000 $97.5000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 28 28 25.276188 $1263.8000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.933333 $23.3300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 7 7 45.276191 $2444.9200 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 5.142857 $277.7200 $54.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 57 64 281.601585 $3379.2300 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 1.000000 $81.3200 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 3.571429 $290.4300 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 2 12.819047 $1042.4400 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 4.285714 $348.5100 $81.3200
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Subtotal (Total Children Is Unduplicated) 116 160 415.393646 $10926.0600 $26.3000
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Total 185 440.188090 $11401.9900 $25.9000
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Number of Children (Unduplicated) With at Least One Authorization 132