Summary Report for FSPSAs Initiated During the Report Period Center: 04
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: 01-01-16 and 03-31-16 Date of Report: 05-12-16 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2162 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 2 2 2.577778 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 2 2.577778 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 3 3 2.422222 $117.4800 $48.5000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 7 7 2.055554 $104.9300 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 62 65 31.063184 $1585.7700 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 15 15 4.333334 $221.2200 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 67 69 37.435964 $1911.1100 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.472222 $24.1100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 47 49 19.217459 $981.0500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 13 13 3.731746 $190.5100 $51.0500
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Subtotal (Total Children Is Unduplicated) 176 222 100.731685 $5136.1700 $50.9900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.002740 $13.5000 $4927.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 35 82 23.532545 $1176.6500 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 7 7 5.994444 $299.7200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1 1 0.133333 $6.6700 $49.9900
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 102 114 635.285703 $15882.1500 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 7.142857 $357.1500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 650 688 4036.173274 $201808.8100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 636 693 4210.688961 $42106.9200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 108 110 508.321424 $36314.5200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 7 7 37.650792 $2153.6300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 95 102 553.214279 $39521.6400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 9 9 39.071428 $2233.3200 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 109 114 596.480945 $42612.6600 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 0.571429 $32.6800 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 6 6 21.071428 $292.4700 $13.8800
TRAV -TRAVS Travel by mile 2 2 8.000000 $3.5600 $0.4500
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Subtotal (Total Children Is Unduplicated) 835 1938 10683.335582 $384816.0500 $36.0200
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Total 2162 10786.645045 $389952.2200 $36.1500
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Number of Children (Unduplicated) With at Least One Authorization 836