Summary Report for FSPSAs Ending During the Report Period Center: 04
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: 04-01-20 and 06-30-20 Date of Report: 07-20-20 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 999 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 44 46 19.766669 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 44 46 19.766669 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 5 5 1.661112 $80.5700 $48.5000
OCTH -97167 OT EVAL HIGH COMPLEXITY 5 5 1.200000 $61.2600 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 6 6 1.655557 $84.5200 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.355556 $18.1500 $51.0600
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.172222 $8.7900 $51.0400
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 5 5 1.383334 $70.6200 $51.0500
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Subtotal (Total Children Is Unduplicated) 17 23 6.427781 $323.9200 $50.3900
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 22 55 11.377776 $568.8800 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3 4 1.144445 $57.2300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 4 5 2.244445 $112.2300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.100000 $2.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1 1 0.933333 $46.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 1.200000 $30.0000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 9.142857 $228.5700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 115 127 803.000003 $40150.0300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 0.714286 $35.7200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 620 705 4330.623019 $43306.2500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 4 21.857143 $1561.4800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 20.000000 $1144.0000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 2 3 16.142857 $1153.2500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 3 24.142857 $1380.0100 $57.1600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 4 5 36.142859 $2067.3700 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 14.714285 $204.2300 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 7 8 47.428570 $1754.8600 $37.0000
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Subtotal (Total Children Is Unduplicated) 656 930 5340.908735 $93803.2500 $17.5600
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Total 999 5367.103185 $94127.1700 $17.5400
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Number of Children (Unduplicated) With at Least One Authorization 689