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: 10-01-18 and 12-31-18 Date of Report: 02-06-19 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 1809 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 3 3 0.893651 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 1.000000 $37.0000 $37.0000
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Subtotal (Total Children Is Unduplicated) 4 4 1.893651 $37.0000 $19.5400
Screening, Eval, and Assessment, Class # 02
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 2 2.000000 $111.0000 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 8 8 13.285714 $737.3600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 8 8 13.285714 $996.4300 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 2 2 0.855556 $43.6800 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 41 43 24.465082 $1248.9600 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 2 0.855556 $43.6800 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 46 47 41.611110 $2124.2500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 65 71 28.969844 $1478.9200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.488889 $24.9600 $51.0500
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Subtotal (Total Children Is Unduplicated) 122 184 125.817465 $6809.2300 $54.1200
EI Services, Class # 03
CONOF -CONOF CONSULT, OT, FACE TO FACE 93 96 49.042061 $2452.0900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 14 15 7.338889 $366.9500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 206 215 147.593652 $7379.6900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 7 13.873809 $346.8400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 42 42 288.285719 $7207.1500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 488 509 3400.771473 $170038.5600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 490 549 3397.232584 $33972.3200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 45 46 231.357147 $16528.1100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 8 8 31.142858 $1781.3600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 40 41 352.214291 $25162.1500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 5 5 16.928572 $967.6300 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 56 60 324.928575 $23212.8600 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 2.714286 $155.2500 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 9 9 38.785715 $538.3400 $13.8800
TRAV -TRAVS Travel by mile 9 17 9740.571427 $4334.5500 $0.4500
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Subtotal (Total Children Is Unduplicated) 547 1621 18042.781058 $294443.8400 $16.3200
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Total 1809 18170.492174 $301290.0700 $16.5800
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Number of Children (Unduplicated) With at Least One Authorization 552