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: 07-01-19 and 09-30-19 Date of Report: 11-04-19 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 877 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 5 5 15.223810 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 0.922222 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 7 7 16.146032 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
OCTH -97167 OT EVAL HIGH COMPLEXITY 7 7 10.544445 $538.3000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 2 0.383333 $19.5700 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 6 6 10.505556 $536.3100 $51.0500
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Subtotal (Total Children Is Unduplicated) 8 15 21.433334 $1094.1700 $51.0500
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 4 0.022224 $1.1200 $50.4000
CONOF -CONOF CONSULT, OT, FACE TO FACE 106 106 45.077776 $2253.8800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 14 14 9.300792 $465.0400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 226 232 102.533333 $5126.6700 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 2.857143 $71.4300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 16 16 135.142858 $6757.1500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 464 481 3195.574645 $31955.7300 $10.0000
PHY -97110 PT SESSION BY LICENSED PT 1 1 3.714286 $265.3500 $71.4400
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Subtotal (Total Children Is Unduplicated) 465 855 3494.223057 $46896.3600 $13.4200
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Total 877 3531.802423 $47990.5400 $13.5900
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Number of Children (Unduplicated) With at Least One Authorization 479