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 978 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 2 2 2.061111 $99.9600 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 6 6 1.683333 $85.9300 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 2 2 0.633334 $32.3400 $51.0600
PSTH -97001 EVAL BY LICENSED PT, INITIAL 6 6 2.044444 $104.3700 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 5 7 1.605556 $81.9700 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 10 10 11.019842 $562.5700 $51.0500
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Subtotal (Total Children Is Unduplicated) 27 33 19.047620 $967.1300 $50.7700
EI Services, Class # 03
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 2 2 11.714286 $292.8600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 106 120 800.058729 $40002.9700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 600 675 4291.906345 $42919.0900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 10 10 60.642857 $4332.3300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 9 11 81.285717 $5807.0500 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 6 7 31.500000 $2250.3600 $71.4400
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Subtotal (Total Children Is Unduplicated) 642 941 5314.841268 $97491.3300 $18.3400
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Total 978 5335.533332 $98458.4600 $18.4500
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Number of Children (Unduplicated) With at Least One Authorization 649