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: 01-01-20 and 03-31-20 Date of Report: 05-15-20 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1686 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
TCM -T1017TL TARGETED CASE MANAGEMENT 24 25 12.847618 $475.3600 $37.0000
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Subtotal (Total Children Is Unduplicated) 24 25 12.847618 $475.3600 $37.0000
Screening, Eval, and Assessment, Class # 02
OCTH -97167 OT EVAL HIGH COMPLEXITY 51 55 31.234921 $1594.5400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 14 14 5.877778 $300.0600 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.433333 $22.1200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 32 36 13.466668 $687.4800 $51.0500
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Subtotal (Total Children Is Unduplicated) 61 106 51.012700 $2604.2000 $51.0500
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 7 13 4.611111 $230.5600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 144 146 75.849998 $3792.4900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 28 29 15.155553 $757.7700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 259 263 136.017459 $6800.8700 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 42 45 390.285716 $9757.1400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 437 451 3163.006340 $158150.3400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 7 7 30.571429 $1528.5700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 454 472 3308.009514 $33080.1000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 50 53 249.785714 $17844.6900 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 22 22 128.785713 $9200.4600 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 51 54 266.642856 $19048.9600 $71.4400
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Subtotal (Total Children Is Unduplicated) 500 1555 7768.721403 $260191.9300 $33.4900
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Total 1686 7832.581721 $263271.5000 $33.6100
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Number of Children (Unduplicated) With at Least One Authorization 513