Summary Report for FSPSAs Initiated During the Report Period Center: 04
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: 07-01-19 and 09-30-19 Date of Report: 11-04-19 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2909 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 35 37 20.314287 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 35 37 20.314287 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 4 6 1.027778 $49.8500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 2.000000 $112.9800 $56.4900
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.194444 $9.9200 $51.0400
OCTH -97167 OT EVAL HIGH COMPLEXITY 132 149 55.455553 $2830.9800 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 116 137 44.244440 $2258.6600 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.066667 $3.4100 $51.0700
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 52 55 12.794446 $653.1600 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.016667 $0.8500 $51.1500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 14 14 3.444445 $168.5700 $48.9400
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Subtotal (Total Children Is Unduplicated) 248 366 119.244440 $6088.3900 $51.0600
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 27 64 29.678568 $1483.9100 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2 2 0.466667 $23.3400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2 2 0.444444 $22.2200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 5 5 4.636508 $231.8300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.366667 $34.1700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 158 221 1236.285718 $30907.2100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 728 807 5700.142905 $285007.2400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 740 864 6064.658790 $60646.6000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 58 58 354.428576 $25320.3600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 103 148 644.285720 $36853.1400 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 61 64 359.080169 $25652.6400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 89 120 606.642867 $34675.7100 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 18 19 95.500001 $6822.5100 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 88 130 531.214296 $7373.2500 $13.8800
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Subtotal (Total Children Is Unduplicated) 945 2506 15629.831896 $515104.0900 $32.9600
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Total 2909 15769.390623 $521192.4800 $33.0500
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Number of Children (Unduplicated) With at Least One Authorization 981