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: 01-01-17 and 03-31-17 Date of Report: 05-05-17 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2244 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 4 1.644444 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 4 4 1.644444 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 3 3 2.255555 $109.3900 $48.5000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 1 1 0.138889 $7.0900 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 54 56 32.476187 $1657.8900 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 30 32 30.119048 $1537.5800 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 3 3 0.783334 $39.9900 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 2 0.177777 $9.0700 $51.0300
PSTH -97001 EVAL BY LICENSED PT, INITIAL 47 47 35.741269 $1824.5900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 32 36 24.803969 $1266.2500 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.044444 $2.2700 $51.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 81 84 36.872222 $1882.3300 $51.0500
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Subtotal (Total Children Is Unduplicated) 203 265 163.412694 $8336.4500 $51.0100
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.377778 $18.8900 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.194444 $13.9200 $71.5900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 31 101 25.333332 $1266.6600 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3 3 1.511112 $75.5600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1 1 0.122222 $6.1100 $49.9900
CONPF -CONPF CONSULT, PT, FACE TO FACE 7 7 9.333334 $466.6700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4 4 1.433334 $71.6700 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 104 127 696.999991 $17425.0200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 625 688 4415.538095 $220777.0500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 601 676 4296.477774 $42964.8000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 110 126 619.419839 $44251.3800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 6.571429 $375.8800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 95 107 630.214283 $45022.5700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 3 9.214285 $526.6900 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 118 129 579.107140 $41371.4300 $71.4400
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Subtotal (Total Children Is Unduplicated) 811 1975 11291.848392 $414634.3100 $36.7200
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Total 2244 11456.905530 $422970.7600 $36.9200
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Number of Children (Unduplicated) With at Least One Authorization 823