Summary Report for FSPSAs Initiated During the Report Period Center: 06
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: 10-01-19 and 12-31-19 Date of Report: 02-01-20 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 1605 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 46 46 44.791271 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 46 46 44.791271 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 73 73 146.000000 $7300.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 73 73 146.000000 $7300.0000 $50.0000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.155556 $7.7800 $50.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 155 159 30.914075 $1545.8900 $50.0100
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 8 8 1.034725 $25.8800 $25.0100
CONIF -CONIF CONSULT, ITDS FACE TO FACE 14 14 23.823808 $1191.1800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 9 9 11.523810 $288.1000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 10 10 16.607142 $830.3500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 6 6 10.073810 $251.8500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 3 3 8.928572 $446.4300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 8 8 16.707143 $835.3600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 1.733334 $43.3400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 218 228 1558.814287 $77940.7300 $50.0000
INTR -T1013 INTERPRETER 22 23 110.676190 $5533.8100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 796 952 6149.253168 $61492.5400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 12 14 47.576191 $3398.8400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 4.300000 $245.9600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 13 16 55.464287 $3962.3600 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 27 28 122.428571 $8746.2900 $71.4400
TRAV -TRAVS Travel by mile 1 1 7.857143 $3.5000 $0.4400
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Subtotal (Total Children Is Unduplicated) 829 1486 8178.871812 $171790.1600 $21.0000
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Total 1605 8369.663083 $179090.1600 $21.4000
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Number of Children (Unduplicated) With at Least One Authorization 907