Summary Report for FSPSAs Ending During the Report Period Center: 06
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: 07-01-24 and 09-30-24 Date of Report: 04-06-25 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1003 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 50 51 76.342064 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 50 51 76.342064 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT COS Exit 109 111 89.250000 $4462.5000 $50.0000
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Subtotal (Total Children Is Unduplicated) 109 111 89.250000 $4462.5000 $50.0000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 0.077778 $5.4000 $69.3700
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 89 94 96.676115 $4833.8100 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 31 33 27.725572 $1386.2800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 42 43 22.468020 $561.7100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 9 9 11.144446 $557.2300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 2.550000 $63.7500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 4 5 5.277778 $263.8900 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 1 1 0.155556 $7.7800 $50.0100
CONOP -CONOP CONSULT, OT, PHONE 2 2 3.883334 $97.0900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 0.333334 $16.6700 $50.0100
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.433333 $35.8300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2 2 2.400000 $120.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 34 38 266.223811 $14376.1000 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 3 9.571429 $516.8600 $54.0000
INTR -T1013 INTERPRETER 41 54 261.290475 $13064.5200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 467 540 3423.033327 $41076.4300 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 16.723810 $1359.9800 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 0.500000 $40.6600 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 1 1 4.428571 $288.3900 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 8.428571 $548.8700 $65.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 3 13.000000 $1057.1600 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 2 12.428571 $1010.6900 $81.3200
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Subtotal (Total Children Is Unduplicated) 515 841 4190.753831 $86289.0600 $20.5900
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Total 1003 4356.345895 $90751.5600 $20.8300
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Number of Children (Unduplicated) With at Least One Authorization 574