Summary Report for FSPSAs Initiated During the Report Period Center: 03
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: 10-01-17 and 12-31-17 Date of Report: 02-03-18 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 1364 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 17 17 9.716666 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 17 17 9.716666 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 29 44 24.627171 $1194.4200 $48.5000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.0500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 8 8 4.544445 $232.0000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 7 7 3.377777 $172.4300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 18 20 11.505557 $587.3700 $51.0500
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Subtotal (Total Children Is Unduplicated) 57 80 45.054950 $2237.2700 $49.6600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 8 8 5.783333 $28916.5000 $4999.9700
CONIF -CONIF CONSULT, ITDS FACE TO FACE 304 341 752.731747 $37636.5800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 147 161 352.771425 $17638.5500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 141 157 302.794442 $15139.7000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 336 382 680.187305 $34009.3900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 133 142 829.101595 $41455.0400 $50.0000
INTR -T1013 INTERPRETER 22 22 174.231746 $8711.5900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 10 11 89.428573 $6388.7600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 15 16 116.419050 $8316.9700 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 23 27 189.776193 $13557.6200 $71.4400
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Subtotal (Total Children Is Unduplicated) 472 1267 3493.225409 $211770.6900 $60.6200
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Total 1364 3547.997025 $214007.9600 $60.3200
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Number of Children (Unduplicated) With at Least One Authorization 493