Summary Report for FSPSAs Initiated During the Report Period Center: 06
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 1771 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 62 62 89.123019 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 62 62 89.123019 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 64 67 139.637182 $6981.8600 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 2.000000 $102.1000 $51.0500
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Subtotal (Total Children Is Unduplicated) 65 68 141.637182 $7083.9600 $50.0100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 3.766667 $188.3400 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 176 181 42.692341 $2134.8100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 11 11 3.025002 $75.6300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 10 10 8.650001 $432.5100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 7 9 9.342856 $233.5700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 5 5 3.861112 $193.0600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 6 2.566667 $64.1700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 3 4 2.894445 $144.7300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 9 9 5.186112 $259.3100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 2.266667 $56.6700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 2 2 29.714286 $742.8600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 237 258 1525.257166 $76262.8700 $50.0000
INTR -T1013 INTERPRETER 25 30 169.714286 $8485.7200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 866 1034 6181.550102 $61815.5000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 12 15 38.590475 $2756.9000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 4 4 23.421428 $1339.7100 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 13 14 54.566667 $3898.2300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 3 9.428572 $538.9300 $57.1600
SENS -V5264 EARMOLD 1 1 0.766667 $13.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 34 38 157.500000 $11251.7800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 0.928571 $12.8900 $13.8800
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Subtotal (Total Children Is Unduplicated) 908 1641 8276.690090 $175901.9600 $21.2500
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Total 1771 8507.450291 $182985.9200 $21.5100
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Number of Children (Unduplicated) With at Least One Authorization 986