Summary Report for FSPSAs Initiated During the Report Period Center: 52
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 632 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 1 1 0.777778 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 0.777778 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 1.000000 $50.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 1 1 1.000000 $50.0000 $50.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 4 7 7.000000 $357.3500 $51.0500
SCREEN-T1023 SCREENING 1 1 1.000000 $50.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 3 5 5.000000 $255.2500 $51.0500
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Subtotal (Total Children Is Unduplicated) 9 16 16.000000 $813.6500 $50.8500
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 2.766667 $138.3400 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 4 5 5.750000 $287.5000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 191 208 533.764282 $26688.2000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.000000 $25.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 113 119 335.576186 $16778.7900 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 1 1 2.666667 $133.3400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 56 57 149.066667 $7453.3400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 176 180 439.014284 $21950.7100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 2.800000 $70.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 16 16 77.080951 $3854.0500 $50.0000
INTR -T1013 INTERPRETER 5 5 50.361905 $2518.0900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 5 6 17.361903 $1240.3300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 19.285714 $1103.1500 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 3 3 17.219047 $1230.1300 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 7 7 47.561904 $3397.8200 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 2.000000 $142.8800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 9.571429 $132.8500 $13.8800
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Subtotal (Total Children Is Unduplicated) 251 615 1712.847606 $87144.4800 $50.8800
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Total 632 1729.625384 $87958.1300 $50.8500
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Number of Children (Unduplicated) With at Least One Authorization 253