Summary Report for FSPSAs Initiated During the Report Period Center: 09
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: 01-01-18 and 03-31-18 Date of Report: 05-05-18 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 1958 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 28 29 40.430161 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 28 29 40.430161 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 2.566667 $128.3400 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 11 13 36.777776 $1838.9000 $50.0000
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 0.050000 $2.5500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 15 17 40.394443 $2020.8300 $50.0300
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 211 271 232.253500 $11612.7000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 68 68 48.647118 $1216.1700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 54 54 36.397728 $1819.9000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.122222 $3.0600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 36 37 17.504947 $875.2500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.083333 $2.0800 $24.9900
CONPF -CONPF CONSULT, PT, FACE TO FACE 36 38 22.002664 $1100.1400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 49 50 38.433334 $1921.6800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 3.377778 $84.4500 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 11.285714 $282.1400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 750 799 4513.501597 $225674.8800 $50.0000
INTR -T1013 INTERPRETER 1 2 9.285714 $464.2900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 100 110 663.819047 $47423.2200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 138 161 942.200003 $67310.7500 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 280 315 1962.690483 $140214.4900 $71.4400
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Subtotal (Total Children Is Unduplicated) 1040 1912 8501.605182 $500005.1500 $58.8100
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Total 1958 8582.429786 $502025.9900 $58.4900
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Number of Children (Unduplicated) With at Least One Authorization 1060