Summary Report for FSPSAs Initiated During the Report Period Center: 52
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 351 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 3 3 0.833333 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 3 3 0.833333 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
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Subtotal (Total Children Is Unduplicated) 1 1 1.000000 $58.1100 $58.1100
EI Services, Class # 03
CONIF -CONIF CONSULT, ITDS FACE TO FACE 133 150 340.533333 $17026.6700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 72 77 205.266665 $10263.3300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 44 49 169.999998 $8499.9900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 55 55 147.033333 $7351.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 8 8 26.866668 $671.6700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6 6 16.200001 $874.8100 $54.0000
INTR -T1013 INTERPRETER 2 2 10.809524 $540.4800 $50.0000
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Subtotal (Total Children Is Unduplicated) 154 347 916.709522 $45228.6000 $49.3400
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Total 351 918.542855 $45286.7100 $49.3000
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Number of Children (Unduplicated) With at Least One Authorization 157