Summary Report for FSPSAs Ending During the Report Period Center: 04
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: 10-01-16 and 12-31-16 Date of Report: 02-04-17 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 961 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 4 5 2.066667 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 4 5 2.066667 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 10 10 3.066667 $148.7300 $48.5000
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 0.126027 $6.3000 $49.9900
NURS -T1001 NURSING ASSESSMENT 1 1 1.142857 $57.1500 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 2 2 0.611111 $31.2000 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 10 11 10.157144 $518.5300 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 9 9 1.500000 $76.5800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 9 10 19.383334 $989.5200 $51.0500
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Subtotal (Total Children Is Unduplicated) 37 44 35.987140 $1828.0000 $50.8000
EI Services, Class # 03
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.372222 $26.6500 $71.6100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 21 62 10.999997 $549.9900 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 7 7 9.186345 $459.3200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 2.577778 $128.8900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1 1 19.714286 $985.7200 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 3 3 22.428571 $560.7200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 108 120 706.409528 $35320.4700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 603 683 4110.764260 $41107.6100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 11 12 74.428573 $5317.1600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 9.571429 $547.4800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 9 9 38.071430 $2719.8100 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 9 11 51.214286 $3658.7500 $71.4400
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Subtotal (Total Children Is Unduplicated) 640 912 5055.738705 $91382.5600 $18.0800
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Total 961 5093.792512 $93210.5600 $18.3000
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Number of Children (Unduplicated) With at Least One Authorization 649