Summary Report for FSPSAs Initiated During the Report Period Center: 06
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 1099 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 55 55 80.511111 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 55 55 80.511111 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 30 30 67.142857 $3357.1500 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 30 30 67.142857 $3357.1500 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 74 75 13.709504 $685.5700 $50.0100
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 5 5 9.588097 $479.4100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 55 57 11.788887 $294.7700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2 2 3.566666 $178.3300 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 3.066667 $153.3400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 5 5 5.616667 $140.4200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3 4 6.999999 $350.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 4.800000 $120.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1 1 0.533333 $26.6700 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 1 1 3.066667 $153.3400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1 1 3.033333 $151.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 1.883333 $47.0800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 119 126 818.114268 $40905.7700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 14 15 113.785714 $5689.2900 $50.0000
INTR -T1013 INTERPRETER 28 31 107.714287 $5385.7100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 564 658 4496.109478 $44961.1200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 3 3 8.500000 $607.2400 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 4.714286 $336.7900 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 5 6 21.857143 $1561.4700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 2.285714 $130.6500 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 11 12 40.357143 $2883.1100 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 6.285714 $449.0500 $71.4400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 593 1014 5687.376900 $105690.7700 $18.5800
-------------------------------------------------------------------------------------------------------------------------------------
Total 1099 5835.030868 $109047.9200 $18.6900
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 653