Summary Report for FSPSAs Initiated During the Report Period Center: 04
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: 01-01-20 and 03-31-20 Date of Report: 05-15-20 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2377 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 48 51 21.300000 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 48 51 21.300000 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 7 7 2.616667 $126.9100 $48.5000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 2 2 0.194444 $9.9200 $51.0400
OCTH -97167 OT EVAL HIGH COMPLEXITY 132 140 52.253964 $2667.5400 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.233333 $11.9100 $51.0400
PSTH -97163 PT EVAL HIGH COMPLEXITY 92 97 34.919047 $1782.6200 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 4 5 1.844443 $94.1500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.505556 $25.8100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 70 73 34.200792 $1745.9500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 6 8 2.055555 $91.5700 $44.5500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 227 334 128.823801 $6556.3800 $50.8900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 25 71 14.758333 $737.9200 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2 2 0.688889 $34.4500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.544444 $13.6100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2 2 0.688889 $34.4500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.544444 $13.6100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2 2 1.194445 $59.7300 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 87 94 621.285718 $15532.1400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 611 650 4636.858724 $231843.0000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 32 32 113.285716 $5664.2800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 657 724 4837.004758 $48370.0600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 96 98 594.642857 $42481.2700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 74 76 431.142861 $24661.3600 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 2.285714 $130.7400 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 67 70 394.214291 $28162.6800 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 4.714286 $336.7900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 47 48 311.857144 $17825.7500 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 37 37 204.000001 $14573.7500 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 45 48 257.357144 $14720.8300 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 3.000000 $214.3200 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 30 32 163.285717 $2266.4000 $13.8800
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 835 1992 12594.354375 $452677.0900 $35.9400
-------------------------------------------------------------------------------------------------------------------------------------
Total 2377 12744.478176 $459233.4700 $36.0300
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 879