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 1501 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
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Subtotal (Total Children Is Unduplicated) 10 10 17.512699 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
OCTH -97167 OT EVAL HIGH COMPLEXITY 12 12 12.783334 $652.5900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 9 9 14.758730 $753.4300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 21 21 18.638889 $951.5200 $51.0500
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Subtotal (Total Children Is Unduplicated) 32 42 46.180953 $2357.5400 $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 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 2 2 9.000000 $225.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 72 74 539.063496 $26953.2000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 730 767 4959.515145 $49595.1400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 5 25.214286 $1801.3100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 5.142857 $294.1700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 6 6 41.285715 $2949.4600 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 11 11 69.214287 $4944.6700 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 13.000000 $180.4400 $13.8800
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Subtotal (Total Children Is Unduplicated) 737 1449 5922.569122 $100000.0800 $16.8800
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Total 1501 5986.262774 $102357.6200 $17.1000
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Number of Children (Unduplicated) With at Least One Authorization 755