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 354 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 24 25 35.374604 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 24 25 35.374604 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.300000 $15.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 0.900000 $45.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 2 2 1.200000 $60.0000 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 74 101 73.973151 $3698.6600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 20 20 12.425728 $310.6400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 20 20 10.299314 $514.9600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 14 14 5.554946 $277.7400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 20 22 12.699999 $635.0000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 21 21 22.097618 $1104.8800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.966667 $49.1700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 82 85 377.357140 $18867.8400 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 9 10 44.171429 $3155.6000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 13 16 73.000000 $5215.1200 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 15 16 88.000001 $6286.7100 $71.4400
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Subtotal (Total Children Is Unduplicated) 200 327 721.545993 $40116.3100 $55.6000
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Total 354 758.120597 $40176.3100 $52.9900
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Number of Children (Unduplicated) With at Least One Authorization 221