Summary Report for FSPSAs Ending During the Report Period Center: 09
This report shows the total number of units/fees for FSPSAs ending during the report period.
(i.e., end 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 ending 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 2625 FSPSA's found of which 63 had no frequency modifier field, FORCE FREQ MODIFIER to 0
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 3 2.444444 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 3 2.444444 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.300000 $15.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 9 12 39.603173 $1980.1600 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.072222 $3.6900 $51.0300
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 0.066667 $3.4100 $51.0700
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Subtotal (Total Children Is Unduplicated) 12 16 40.042062 $2002.2500 $50.0000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.433333 $2166.5000 $4999.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 177 213 30.120157 $1505.9800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 68 77 15.869361 $396.7200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 163 349 564.957262 $28247.8600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 5 7 1.130520 $28.2700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 6 7 7.570635 $378.5300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 5 5 4.457936 $222.9000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 10 12 0.887300 $44.3600 $49.9900
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 545 602 3390.185722 $169509.2300 $50.0000
INTR -T1013 INTERPRETER 9 9 182.714286 $9135.7200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 116 130 754.719055 $53917.1300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 161 181 1082.652390 $77344.6400 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 305 343 2184.204779 $156039.5400 $71.4400
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 500 670 3265.066634 $1632.5300 $0.5000
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Subtotal (Total Children Is Unduplicated) 958 2606 11484.969370 $500569.9000 $43.5800
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Total 2625 11527.455876 $502572.1500 $43.6000
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Number of Children (Unduplicated) With at Least One Authorization 960