Summary Report for FSPSAs Ending During the Report Period Center: 57
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 1676 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 0.969841 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 12.714286 $470.4300 $37.0000
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Subtotal (Total Children Is Unduplicated) 4 4 13.684127 $470.4300 $34.3800
Screening, Eval, and Assessment, Class # 02
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 0.227778 $11.6300 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 11 12 3.811111 $194.5600 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 2 0.277778 $14.1800 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 11 12 15.642063 $798.5200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 22 22 8.044445 $410.6700 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.338889 $16.5900 $48.9400
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Subtotal (Total Children Is Unduplicated) 39 50 28.342064 $1446.1500 $51.0200
EI Services, Class # 03
CONOF -CONOF CONSULT, OT, FACE TO FACE 145 155 77.100788 $3855.0200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.172222 $4.3100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 17 18 9.215078 $460.7500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 361 395 222.029357 $11101.4400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 1.722222 $43.0600 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 11 12 53.557936 $1338.9500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 96 106 647.610316 $32380.5300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 769 863 5461.953937 $54619.5600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 16 16 76.285712 $5449.8600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 3.428571 $196.1200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 11 11 65.642856 $4689.5300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 3.500000 $200.0600 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 21 21 103.214285 $7373.6400 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 6.000000 $83.2800 $13.8800
TRAV -TRAVS Travel by mile 15 15 12729.999999 $5664.8500 $0.4500
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Subtotal (Total Children Is Unduplicated) 788 1622 19461.433279 $127460.9300 $6.5500
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Total 1676 19503.459470 $129377.5100 $6.6300
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Number of Children (Unduplicated) With at Least One Authorization 790