Summary Report for FSPSAs Initiated During the Report Period Center: 06
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: 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 890 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 41 42 55.326194 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 41 42 55.326194 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT COS Exit 109 110 87.250000 $4362.5000 $50.0000
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Subtotal (Total Children Is Unduplicated) 109 110 87.250000 $4362.5000 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 87 91 80.642782 $4032.1400 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 33 34 27.997795 $1399.8900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 42 42 22.747186 $568.6800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5 5 7.511111 $375.5600 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 2 2 2.266667 $113.3400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 5 5 7.304762 $182.6200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2 2 2.344444 $117.2200 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 3 3 3.000000 $150.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.066667 $26.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 3.500000 $175.0000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 4.666666 $116.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2 2 1.933333 $96.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.000000 $25.0000 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 28.571429 $714.2900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 30 33 179.304767 $9682.4500 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 2 7.780953 $420.1700 $54.0000
INTR -T1013 INTERPRETER 42 57 328.109524 $16405.4700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 385 450 2855.700036 $34268.4100 $12.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 2 0.857143 $69.7100 $81.3300
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 9.285714 $755.1100 $81.3200
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Subtotal (Total Children Is Unduplicated) 425 738 3575.590979 $69695.0400 $19.4900
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Total 890 3718.167173 $74057.5400 $19.9200
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Number of Children (Unduplicated) With at Least One Authorization 556