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
Eligibility Filter: Program Patients
With the filters selected there were 2697 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 38 39 28.423809 $1051.6800 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 38 39 28.423809 $1051.6800 $37.0000
Screening, Eval, and Assessment, Class # 02
OCTH -97167 OT EVAL HIGH COMPLEXITY 69 73 43.073810 $2198.9200 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 2 1.150000 $58.7100 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 32 34 15.066666 $769.1500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 0.894444 $45.6600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 69 77 37.362699 $1907.3700 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 1.233333 $54.9400 $44.5500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 122 191 98.780952 $5034.7400 $50.9700
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 237 243 133.011110 $6650.5500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 33 34 17.355553 $867.7700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 406 419 215.889678 $10794.4700 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 55 58 485.428573 $12135.7200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 687 729 4970.211109 $248510.5300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 9 9 38.571429 $1928.5700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 711 757 5166.357140 $51663.5600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 67 70 341.095240 $24367.8300 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 3.285714 $234.7300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 39 42 233.571428 $16686.3400 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 87 91 476.928574 $34071.7500 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 4.714286 $65.4300 $13.8800
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 773 2467 12091.030945 $408207.8000 $33.7600
-------------------------------------------------------------------------------------------------------------------------------------
Total 2697 12218.235706 $414294.2300 $33.9100
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 797