Summary Report for FSPSAs Initiated During the Report Period Center: 52
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: 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 800 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 3 3 5.433333 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.100000 $3.7000 $37.0000
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Subtotal (Total Children Is Unduplicated) 4 4 5.533333 $3.7000 $0.6700
Screening, Eval, and Assessment, Class # 02
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 2 2 1.366667 $69.7700 $51.0500
SCREEN-T1023 SCREENING 6 6 4.640640 $232.0400 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 2.000000 $102.1000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.011111 $51.6200 $51.0500
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Subtotal (Total Children Is Unduplicated) 11 12 9.018418 $455.5200 $50.5100
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 14 15 18.174964 $908.7600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.066667 $26.6700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 205 245 510.600599 $25529.9700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 154 186 425.738813 $21286.9400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 86 89 200.722220 $10036.1000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 188 194 428.677774 $21433.8700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 12 12 63.830951 $3191.5600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 9 10 81.904760 $5851.2800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 3.600000 $205.9200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 5 5 14.892857 $1063.9500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 11.428571 $653.2600 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 22 25 122.738096 $8768.4200 $71.4400
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Subtotal (Total Children Is Unduplicated) 307 784 1883.376272 $98956.6800 $52.5400
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Total 800 1897.928023 $99415.9000 $52.3800
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Number of Children (Unduplicated) With at Least One Authorization 311