Summary Report for FSPSAs Initiated During the Report Period Center: 09
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: 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 2048 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 28 28 44.742859 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 28 28 44.742859 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 4 5 13.223810 $661.1900 $50.0000
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 5 6 14.223810 $712.2400 $50.0700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.000000 $10000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 124 194 272.835923 $13641.7900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 223 316 336.038147 $8400.9600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 55 61 56.291270 $2814.5700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 3 3.472222 $86.8100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 42 43 73.711110 $3685.5500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 34 36 32.930236 $1646.5200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 56 57 63.999284 $3199.9700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 7 6.544444 $163.6100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 633 689 4304.031743 $215201.5900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 114 121 751.971429 $53720.8400 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 5.571429 $398.0200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 128 143 882.173018 $63022.4300 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 313 337 2205.418253 $157555.1600 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 4 4 45.857143 $3276.0300 $71.4400
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Subtotal (Total Children Is Unduplicated) 931 2014 9042.845651 $536813.8200 $59.3600
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Total 2048 9101.812320 $537526.0600 $59.0600
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Number of Children (Unduplicated) With at Least One Authorization 958