Summary Report for FSPSAs Initiated During the Report Period Center: 53
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 186 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 10 10 13.966666 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 10 10 13.966666 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 1.000000 $48.5000 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 2.422222 $57.4100 $23.7000
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Subtotal (Total Children Is Unduplicated) 4 4 3.422222 $105.9100 $30.9500
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 2 4 4.250000 $212.5000 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 11 13 8.571428 $428.5800 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 4 4 5.138095 $256.9000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 16 16 28.802380 $1440.1200 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 32 33 43.794440 $2189.7000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 5 5 8.661111 $216.5300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 0.794445 $39.7300 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 13 13 18.455553 $922.7700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 5.400000 $135.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 15 15 16.961111 $848.0600 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 15 15 18.138888 $906.9400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 2.816666 $70.4200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 7 7 35.885714 $1794.2900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 10 10 46.207143 $2310.3600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 21 23 90.684126 $906.8400 $10.0000
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 2 14.276190 $1019.8900 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 2.100000 $150.0200 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 4 4 32.219047 $2301.7300 $71.4400
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Subtotal (Total Children Is Unduplicated) 126 172 383.156337 $16150.3500 $42.1500
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Total 186 400.545225 $16256.2600 $40.5900
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Number of Children (Unduplicated) With at Least One Authorization 137