Summary Report for FSPSAs Ending During the Report Period Center: 09
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 476 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
CASE -CASE NON-TCM CASE MANAGEMENT 1 1 1.966667 $72.7700 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 31 32 65.326983 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 32 33 67.293650 $72.7700 $1.0800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 3 3.000000 $15000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 60 96 153.318873 $7665.9400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 22 27 25.288562 $632.2200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 32 33 61.583333 $3079.1700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.155556 $3.8900 $25.0100
CONOF -CONOF CONSULT, OT, FACE TO FACE 27 27 27.895238 $1394.7700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 23 23 38.723809 $1936.1900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 39 40 47.553175 $2377.6600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.155556 $28.8900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 87 90 579.795243 $28989.7400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 11.714286 $585.7200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 20 25 131.095238 $9365.4400 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 15 15 98.990475 $7071.8900 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 54 60 364.995243 $26075.2600 $71.4400
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Subtotal (Total Children Is Unduplicated) 246 443 1545.264587 $104206.7500 $67.4400
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Total 476 1612.558237 $104279.5200 $64.6700
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Number of Children (Unduplicated) With at Least One Authorization 278