Summary Report for FSPSAs Ending During the Report Period Center: 52
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 827 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 1 1 1.033333 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 1.033333 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 0.744444 $36.1000 $48.5000
EXIT -EXIT EXIT ASSESSMENT 1 1 1.000000 $50.0000 $50.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 2 2 1.744444 $89.0500 $51.0500
SCREEN-T1023 SCREENING 5 5 4.783497 $239.1800 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 2.355555 $120.2500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 12 14 11.627940 $585.6300 $50.3600
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 2.300000 $115.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 13 14 11.441630 $572.0900 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 219 303 521.360961 $26068.0500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.533333 $13.3300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 132 170 338.772147 $16938.6100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 73 77 172.033329 $8601.6500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 170 185 372.619043 $18630.9300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 1.833333 $45.8300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 11 11 123.971428 $6198.5800 $50.0000
INTR -T1013 INTERPRETER 2 2 30.057143 $1502.8600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 8 9 32.409524 $2315.3300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 1.428572 $81.7100 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 5 5 19.633332 $1402.6100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 1.714286 $97.9900 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 25 26 141.328573 $10096.5100 $71.4400
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Subtotal (Total Children Is Unduplicated) 303 812 1771.436634 $92681.0500 $52.3200
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Total 827 1784.097907 $93266.6800 $52.2800
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Number of Children (Unduplicated) With at Least One Authorization 309