Summary Report for FSPSAs Ending During the Report Period Center: 53
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: 04-01-21 and 06-30-21 Date of Report: 07-15-21 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 219 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 7 7 4.438888 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 7 7 4.438888 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 2 2 2.000000 $97.0000 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 1.788889 $42.4000 $23.7000
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Subtotal (Total Children Is Unduplicated) 4 4 3.788889 $139.4000 $36.7900
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 7 8 7.005556 $350.2800 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 12 12 12.000000 $600.0000 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 4 4 3.817460 $190.8800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.000000 $25.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 21 22 19.562699 $978.1400 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 34 36 44.833333 $2241.6700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 5.000000 $125.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 1.938889 $96.9500 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 12 12 17.255555 $862.7800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 14 16 16.716667 $835.8400 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 17 17 18.844444 $942.2200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 10 10 8.016667 $200.4200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 7 8 44.942857 $2247.1400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 5 5 26.373810 $1318.7000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 38 43 149.947618 $1499.4800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 1.857143 $132.6700 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 3.666667 $261.9500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1 1 11.714286 $836.8700 $71.4400
SENS -V5264 EARMOLD 1 1 2.000000 $36.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 0.966667 $69.0600 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 5.266667 $376.2500 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 2 2 11.142857 $796.0500 $71.4400
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Subtotal (Total Children Is Unduplicated) 151 208 413.869842 $15023.3100 $36.3000
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Total 219 422.097619 $15162.7100 $35.9200
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Number of Children (Unduplicated) With at Least One Authorization 158