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: 01-01-25 and 03-31-25 Date of Report: 04-06-25 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 769 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 34 34 34.419843 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 34 34 34.419843 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT COS Exit 81 81 81.000000 $4050.0000 $50.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $119.8400 $59.9200
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Subtotal (Total Children Is Unduplicated) 82 82 83.000000 $4169.8400 $50.2400
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 75 77 64.234015 $3211.7100 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 37 37 28.212264 $1410.6200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 30 30 29.560914 $739.0300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3 3 2.200000 $110.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2 2 2.066667 $103.3400 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 1 1 0.133333 $6.6700 $49.9900
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 17 17 118.304763 $6388.4600 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 9.428571 $509.1400 $54.0000
INTR -T1013 INTERPRETER 69 102 345.500001 $17275.0100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 334 381 2337.657172 $28051.8800 $12.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 2 2.428571 $197.4900 $81.3200
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Subtotal (Total Children Is Unduplicated) 385 653 2939.726271 $58003.3400 $19.7300
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Total 769 3057.146114 $62173.1800 $20.3400
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Number of Children (Unduplicated) With at Least One Authorization 487