Summary Report for FSPSAs Initiated During the Report Period Center: 06
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 1332 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 42 42 58.799207 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 42 42 58.799207 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 17 17 34.000000 $1700.0000 $50.0000
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 18 18 35.000000 $1751.0500 $50.0300
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 173 181 9.631760 $481.8900 $50.0300
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 10 11 0.201391 $5.0400 $25.0300
CONIF -CONIF CONSULT, ITDS FACE TO FACE 28 28 33.872223 $1693.6200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 5 5 3.283334 $82.0900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 15 15 14.455557 $722.7900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 5 5 5.066667 $126.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 11 11 16.383332 $819.1600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 4 4 2.450001 $61.2500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 24 25 32.851588 $1642.5800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 6.216667 $155.4200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 41 43 291.285716 $14564.2800 $50.0000
INTR -T1013 INTERPRETER 12 15 57.000000 $2850.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 676 860 5281.865931 $52818.6200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 15 17 62.924997 $4495.3500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 18 19 74.792857 $5343.2000 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.084932 $5.5200 $64.9800
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 25 27 126.178571 $9014.2100 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 3.000000 $41.6400 $13.8800
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Subtotal (Total Children Is Unduplicated) 698 1272 6021.545524 $94923.3100 $15.7600
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Total 1332 6115.344731 $96674.3600 $15.8100
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Number of Children (Unduplicated) With at Least One Authorization 734