Summary Report for FSPSAs Initiated During the Report Period Center: 57
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 1885 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 3.366666 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.977778 $36.1800 $37.0000
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Subtotal (Total Children Is Unduplicated) 6 6 4.344444 $36.1800 $8.3300
Screening, Eval, and Assessment, Class # 02
AUDE -92585 AUD EVOKED RESPONSE (COMP) 3 3 2.250000 $173.5400 $77.1300
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 1.000000 $55.5000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 1.000000 $75.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 12 12 4.483334 $228.8800 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 41 42 16.916664 $863.5800 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 22 22 10.078568 $514.5000 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.333333 $17.0200 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 20 20 6.711111 $342.6000 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.300000 $15.3200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 60 62 45.341268 $2314.6500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 15 15 6.294444 $321.3300 $51.0500
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Subtotal (Total Children Is Unduplicated) 128 180 94.708722 $4921.9100 $51.9700
EI Services, Class # 03
CONOF -CONOF CONSULT, OT, FACE TO FACE 109 109 62.339678 $3116.9700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.522222 $13.0600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 19 19 23.114287 $1155.7200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 344 351 177.161899 $8858.0600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 83 86 602.199216 $30109.9400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 586 990 4430.077848 $44300.7300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 25 25 183.190479 $13087.1100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 1.857143 $106.2300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 30 30 215.934130 $15426.3100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 16.071428 $918.6500 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 39 39 261.714286 $18696.8600 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 17.428571 $996.9200 $57.2000
TRAV -TRAVS Travel by mile 20 45 23516.547623 $10464.8600 $0.4500
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Subtotal (Total Children Is Unduplicated) 636 1699 29508.158810 $147251.3900 $4.9900
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Total 1885 29607.211976 $152209.4800 $5.1400
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Number of Children (Unduplicated) With at Least One Authorization 657