Summary Report for FSPSAs Ending During the Report Period Center: 09
This report shows the total number of units/fees for FSPSAs ending during the report period.
(i.e., end 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 ending 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 606 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 37 37 56.784918 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 37 37 56.784918 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 4.433333 $221.6700 $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) 3 3 6.433333 $323.7700 $50.3300
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 105 140 177.964637 $8898.2500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 37 38 27.313469 $682.8400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 27 27 36.240477 $1812.0300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 28 31 54.358730 $2717.9300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 1.400000 $35.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 28 30 41.448413 $2072.4300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 0.600000 $15.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 28 28 29.625398 $1481.2800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 6 5.600000 $140.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 144 152 1064.871422 $53243.5900 $50.0000
INTR -T1013 INTERPRETER 1 1 3.000000 $150.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 16 17 117.804761 $8415.9800 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 19 19 132.147618 $9440.6300 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 65 71 476.566665 $34045.9500 $71.4400
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Subtotal (Total Children Is Unduplicated) 332 566 2168.941590 $123150.8900 $56.7800
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Total 606 2232.159841 $123474.6500 $55.3200
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Number of Children (Unduplicated) With at Least One Authorization 370