Summary Report for FSPSAs Ending During the Report Period Center: 57
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 1849 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 63 63 38.285716 $1416.5800 $37.0000
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Subtotal (Total Children Is Unduplicated) 63 63 38.285716 $1416.5800 $37.0000
Screening, Eval, and Assessment, Class # 02
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 0.038889 $1.9900 $51.0600
OCTH -97167 OT EVAL HIGH COMPLEXITY 16 16 5.122222 $261.4900 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.038889 $1.9900 $51.0600
PSTH -97163 PT EVAL HIGH COMPLEXITY 8 8 2.066667 $105.5100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 21 21 6.749999 $344.5800 $51.0500
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Subtotal (Total Children Is Unduplicated) 31 47 14.016666 $715.5500 $51.0500
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 2 0.711112 $35.5600 $50.0100
CONOF -CONOF CONSULT, OT, FACE TO FACE 253 260 106.366668 $5318.3400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 39 41 19.827777 $991.3900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 461 479 209.230959 $10461.5900 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 2.285714 $57.1400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 76 77 368.142855 $18407.1500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 813 851 4843.333309 $48433.3400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 8 8 12.214285 $872.5900 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 5 5 14.714285 $1051.1900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 6.714286 $383.7900 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 13 13 65.571427 $4684.4400 $71.4400
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Subtotal (Total Children Is Unduplicated) 824 1739 5649.112677 $90696.5000 $16.0500
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Total 1849 5701.415059 $92828.6200 $16.2800
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Number of Children (Unduplicated) With at Least One Authorization 850