Summary Report for FSPSAs Initiated During the Report Period Center: 03
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: 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 1347 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 54 54 28.850003 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 54 54 28.850003 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 24 29 23.094445 $1120.0800 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 3 3.000000 $83.4900 $27.8300
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 0.250000 $12.7600 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 46 52 22.667655 $1157.1800 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.077778 $3.9700 $51.0600
PSTH -97163 PT EVAL HIGH COMPLEXITY 56 63 27.686607 $1413.4100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 63 80 36.256243 $1850.8900 $51.0500
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Subtotal (Total Children Is Unduplicated) 166 229 113.032728 $5641.7900 $49.9100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 27 29 25.135845 $125679.5000 $5000.0100
CONIF -CONIF CONSULT, ITDS FACE TO FACE 19 19 28.547619 $1427.3800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 99 110 131.816669 $6590.8500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 53 57 78.288890 $3914.4500 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 1 1 0.744444 $37.2200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 147 169 175.511111 $8775.5600 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 2 3 4.133333 $206.6700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 306 425 1779.661886 $88983.1300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 2 15.733333 $786.6700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 51 69 369.195232 $26375.3600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 1.571429 $89.8800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 57 79 355.928568 $25427.5700 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 67 100 433.080949 $30939.3300 $71.4400
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Subtotal (Total Children Is Unduplicated) 501 1064 3399.349308 $319233.5400 $93.9100
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Total 1347 3541.232039 $324875.3300 $91.7400
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Number of Children (Unduplicated) With at Least One Authorization 551