Summary Report for FSPSAs Ending During the Report Period Center: 52
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: 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 788 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 4 4 1.555556 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 4 4 1.555556 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 3 3 3.000000 $150.0000 $50.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 3 3 3.000000 $153.1500 $51.0500
SCREEN-T1023 SCREENING 5 5 5.000000 $250.0000 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 2.000000 $102.1000 $51.0500
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Subtotal (Total Children Is Unduplicated) 13 13 13.000000 $655.2500 $50.4000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.811111 $4055.5000 $4999.9300
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 3.366667 $168.3400 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 17 19 20.816667 $1040.8400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.366667 $34.1700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 220 273 541.066670 $27053.3500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 147 173 354.816667 $17740.8400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 80 86 178.733334 $8936.6700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 155 168 334.766665 $16738.3300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 4.733333 $118.3300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 18 18 101.204760 $5060.2400 $50.0000
INTR -T1013 INTERPRETER 4 4 23.142857 $1157.1400 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 8 8 36.219047 $2587.4900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 4.800000 $274.5600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 6 6 42.866666 $3062.3900 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 8 10 47.661904 $3404.9700 $71.4400
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Subtotal (Total Children Is Unduplicated) 288 771 1696.373015 $91433.1400 $53.9000
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Total 788 1710.928571 $92088.3900 $53.8200
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Number of Children (Unduplicated) With at Least One Authorization 298