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 672 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 23 28 22.094445 $1071.5800 $48.5000
OCTH -97167 OT EVAL HIGH COMPLEXITY 6 6 1.877244 $95.8300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 9 11 6.727777 $343.4500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 13 15 5.800000 $296.0900 $51.0500
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Subtotal (Total Children Is Unduplicated) 45 60 36.499466 $1806.9500 $49.5100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 9 8.250000 $41250.0000 $5000.0000
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 108 150 639.409515 $31970.5000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 4.733333 $236.6700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 7 10 49.495238 $3535.9400 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 9 13 50.442856 $3603.6300 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 13 16 89.914283 $6423.4800 $71.4400
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Subtotal (Total Children Is Unduplicated) 324 558 1261.287291 $107972.3300 $85.6000
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Total 672 1326.636760 $109779.2800 $82.7500
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Number of Children (Unduplicated) With at Least One Authorization 382