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 998 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 2 2 0.488889 $23.7100 $48.5000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 1 1 0.444444 $22.6900 $51.0400
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 10 10 2.383333 $121.6700 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 13 13 10.261905 $523.8800 $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 16 16 9.517460 $485.8700 $51.0500
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Subtotal (Total Children Is Unduplicated) 40 43 23.568253 $1201.9200 $51.0000
EI Services, Class # 03
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 2 2 9.428571 $235.7200 $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 124 126 704.551578 $35227.6200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 635 690 4191.117533 $41911.2000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 14 15 92.499997 $6608.2200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 2.142857 $122.5700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 9 11 44.571427 $3184.2000 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 13 13 72.571426 $5184.5200 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 3.714285 $51.5500 $13.8800
TRAV -TRAVS Travel by mile 2 2 8.000000 $3.5600 $0.4500
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Subtotal (Total Children Is Unduplicated) 678 953 5165.400853 $94369.3300 $18.2700
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Total 998 5191.546884 $95571.2500 $18.4100
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Number of Children (Unduplicated) With at Least One Authorization 686