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: 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 1023 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 5 5 2.355556 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 5 2.355556 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 6 6 3.611111 $175.1400 $48.5000
OCTH -97167 OT EVAL HIGH COMPLEXITY 12 12 3.399999 $173.5600 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.172222 $8.7900 $51.0400
PSTH -97163 PT EVAL HIGH COMPLEXITY 11 12 13.661906 $697.4500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 8 8 1.544444 $78.8400 $51.0500
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Subtotal (Total Children Is Unduplicated) 31 39 22.389682 $1133.7900 $50.6400
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 37 80 16.177781 $808.9100 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 6 6 3.055556 $152.7800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 5 5 2.538890 $126.9500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 1.155556 $57.7800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2 2 0.433333 $21.6700 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 0.285714 $7.1400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 107 114 935.702386 $46785.1100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 648 734 5485.966705 $54859.6400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 13 13 77.714287 $5551.9100 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 12 13 94.571428 $6756.2000 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 9 9 50.142857 $3582.2100 $71.4400
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Subtotal (Total Children Is Unduplicated) 700 979 6667.744493 $118710.2800 $17.8000
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Total 1023 6692.489731 $119844.0700 $17.9100
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Number of Children (Unduplicated) With at Least One Authorization 707