Summary Report for FSPSAs Ending During the Report Period Center: 03
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: 10-01-20 and 12-31-20 Date of Report: 01-23-21 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 734 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 64 65 30.677774 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 64 65 30.677774 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 20 22 18.664014 $905.2100 $48.5000
OCTH -97167 OT EVAL HIGH COMPLEXITY 4 4 1.155555 $58.9900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 7 8 4.766667 $243.3400 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 10 10 4.316666 $220.3600 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 0.677777 $30.1900 $44.5400
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Subtotal (Total Children Is Unduplicated) 42 47 30.580679 $1509.1400 $49.3500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 4 3.127778 $15639.0000 $5000.0400
CONIF -CONIF CONSULT, ITDS FACE TO FACE 14 17 23.033333 $1151.6700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 110 124 148.561113 $7428.0700 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 3 3 1.500000 $75.0000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 63 67 66.299998 $3314.9900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 189 203 204.219048 $10210.9600 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 6 7 5.233332 $261.6600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 144 160 631.974606 $31598.7200 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 2 6.600000 $330.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 8 8 18.047620 $1289.3300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 10 11 34.947620 $2496.6600 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 14 15 60.980954 $4356.4800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 3.000000 $41.6400 $13.8800
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Subtotal (Total Children Is Unduplicated) 399 622 1207.525402 $78194.1500 $64.7600
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Total 734 1268.783855 $79703.3000 $62.8200
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Number of Children (Unduplicated) With at Least One Authorization 468