Summary Report for FSPSAs Initiated During the Report Period Center: 04
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 1721 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 21 21 13.933332 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 21 21 13.933332 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $56.4900 $56.4900
NURS -T1001 NURSING ASSESSMENT 1 1 1.571429 $78.5700 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 4 4 0.716667 $36.5900 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 2 2 0.372222 $19.0000 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 67 69 17.966669 $917.2100 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.288889 $14.7500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 34 36 9.522222 $486.1100 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.316667 $16.1700 $51.0600
SPCH -92522 EVAL OF SPCH SOUND PROD 3 3 0.866667 $44.2500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 44 45 10.783329 $550.4700 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.288889 $14.7500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 8 8 2.788889 $124.2500 $44.5500
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Subtotal (Total Children Is Unduplicated) 132 172 46.482539 $2358.5900 $50.7400
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.188889 $9.4500 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 8 20 2.477775 $123.8800 $49.9900
CONIP -CONIP CONSULT, ITDS PHONE 4 4 3.522223 $88.0600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 13 13 3.755556 $187.7800 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 1 1 6.285714 $314.2900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 7 7 3.355556 $83.8900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 9 9 8.002380 $400.1200 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 1 1 0.088889 $4.4500 $50.0100
CONPP -CONPP CONSULT, PT, PHONE 3 3 1.716667 $42.9200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 11 11 5.953968 $297.7000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 6 4.605556 $115.1400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 67 82 512.428565 $12810.7300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 542 577 4149.285684 $207464.3700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 8.714286 $435.7200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 529 561 4044.661875 $40446.6400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 73 74 465.571426 $33260.4300 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 14.857143 $1061.3900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 22 23 133.357141 $7628.0400 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 42 43 223.486509 $15965.8700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 8 8 49.214286 $2813.0900 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 3 3 36.714285 $2098.6000 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 62 64 350.928570 $25070.3500 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 3 14.071429 $804.8800 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 11 11 81.357144 $1129.2400 $13.8800
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Subtotal (Total Children Is Unduplicated) 653 1528 10124.601516 $352656.9800 $34.8300
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Total 1721 10185.017387 $355015.5700 $34.8600
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Number of Children (Unduplicated) With at Least One Authorization 671