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
Eligibility Filter: Program Patients
With the filters selected there were 2797 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 8 8 16.590477 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 0.922222 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 2 2 13.049207 $482.8200 $37.0000
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Subtotal (Total Children Is Unduplicated) 11 12 30.561906 $482.8200 $15.8000
Screening, Eval, and Assessment, Class # 02
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 0.388889 $19.8500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 55 55 37.351589 $1906.8000 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 2 0.738889 $37.7200 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 31 33 35.771428 $1826.1200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 66 69 40.946034 $2090.3000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 2 0.466667 $22.8400 $48.9400
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Subtotal (Total Children Is Unduplicated) 104 162 115.663496 $5903.6500 $51.0400
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 182 188 79.800000 $3990.0000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 18 18 10.756348 $537.8200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 362 372 170.554764 $8527.7600 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 116 138 634.999999 $15875.0600 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 4.000000 $200.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 732 773 4964.499271 $248224.8900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 730 767 4959.515145 $49595.1400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 113 134 391.272241 $27952.3700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 5 5 10.568254 $604.5000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 58 67 235.822629 $16847.1200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 0.857143 $48.9900 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 125 144 421.311529 $30098.3800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 11 11 39.928573 $554.2100 $13.8800
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Subtotal (Total Children Is Unduplicated) 838 2623 11923.908120 $403057.3500 $33.8000
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Total 2797 12070.133522 $409443.8100 $33.9200
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Number of Children (Unduplicated) With at Least One Authorization 853