Summary Report for FSPSAs Initiated During the Report Period Center: 04
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: 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 2756 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 2.077777 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 4 4 2.077777 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 12 12 8.743575 $424.0600 $48.5000
OCTF -97168 OT RE-EVAL EST PLAN CARE 2 2 0.633334 $32.3400 $51.0600
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 31 33 10.811109 $551.9000 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 102 125 64.993648 $3317.9100 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 1 1 0.400000 $20.4200 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 4 6 1.361112 $69.4900 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 21 21 20.119841 $1027.1200 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 87 116 50.257146 $2565.6500 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 0.300000 $15.3200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 90 100 35.082541 $1790.9700 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 2 2 0.238889 $12.2000 $51.0500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 275 420 192.941195 $9827.3600 $50.9300
EI Services, Class # 03
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.305556 $21.8800 $71.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 23 62 12.816665 $640.8300 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 24 24 11.883333 $594.1700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 20 20 14.183332 $709.1600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 6 6 5.600000 $280.0000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 12 12 5.866666 $293.3300 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 94 110 561.714282 $14042.8800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 777 811 6177.911093 $308895.7400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 767 829 6201.344424 $62013.4800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 170 181 935.071435 $66801.4700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 3 3 7.335715 $419.6000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 128 135 679.785718 $48563.9400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 10.428571 $596.1000 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 126 135 608.940482 $43502.7100 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 12.428571 $172.5100 $13.8800
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 974 2332 15245.615843 $547547.7900 $35.9200
-------------------------------------------------------------------------------------------------------------------------------------
Total 2756 15440.634815 $557375.1500 $36.1000
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 996