Summary Report for FSPSAs Initiated During the Report Period Center: 57
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 2252 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
TCM -T1017TL TARGETED CASE MANAGEMENT 21 21 20.404763 $754.9900 $37.0000
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Subtotal (Total Children Is Unduplicated) 21 21 20.404763 $754.9900 $37.0000
Screening, Eval, and Assessment, Class # 02
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.0500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 33 37 19.707937 $1006.0900 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.288889 $14.7500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 16 20 12.527779 $639.5500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 38 44 32.580954 $1663.2700 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 4 1.738889 $77.4700 $44.5500
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Subtotal (Total Children Is Unduplicated) 71 107 67.844448 $3452.1700 $50.8800
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 3 9 1.627779 $81.4000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 280 284 262.061110 $13103.0600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 48 49 128.238095 $6411.9100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 378 386 293.806345 $14690.3100 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 28 28 276.571428 $6914.2900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 596 624 4113.407887 $205670.5600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 597 635 4133.865031 $41338.6800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 37 38 189.214289 $13517.4700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 4 4 30.000000 $1716.0100 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 16 16 108.642858 $7761.4500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 7.667460 $438.2700 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 46 47 296.857142 $21207.4900 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 9.571429 $132.8500 $13.8800
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Subtotal (Total Children Is Unduplicated) 621 2124 9851.530853 $332983.7400 $33.8000
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Total 2252 9939.780064 $337190.9000 $33.9200
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Number of Children (Unduplicated) With at Least One Authorization 640