Summary Report for FSPSAs Ending During the Report Period Center: 04
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: 10-01-21 and 12-31-21 Date of Report: 02-04-22 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 959 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 43 43 22.772226 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 43 43 22.772226 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 2 2 0.566666 $27.4800 $48.4900
OCTH -97167 OT EVAL HIGH COMPLEXITY 12 13 2.216666 $113.1600 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 5 8 13.675397 $698.1300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 7 7 1.022222 $52.1800 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 3.857143 $171.8300 $44.5500
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Subtotal (Total Children Is Unduplicated) 19 31 21.338094 $1062.7800 $49.8100
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 18 47 9.677781 $483.9100 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 1 2 0.088888 $4.4400 $49.9500
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1 1 0.005556 $0.2800 $50.4000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 1.211111 $30.2800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2 2 0.261111 $13.0600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 6.473810 $161.8500 $25.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.644444 $16.1100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1 1 0.005556 $0.2800 $50.4000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.644444 $16.1100 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 3 3 5.714286 $142.8600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 109 117 831.571427 $41578.5900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 2 12.714285 $635.7200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 622 677 4383.883343 $43838.8400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 9 9 34.478571 $2463.1500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 1.857143 $106.2300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 3 5 33.714286 $2408.5500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 2 3.857143 $220.4700 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 5 5 15.714286 $1122.6300 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 2 3 13.142857 $182.4200 $13.8800
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Subtotal (Total Children Is Unduplicated) 655 885 5355.660328 $93425.7500 $17.4400
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Total 959 5399.770648 $94488.5400 $17.5000
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Number of Children (Unduplicated) With at Least One Authorization 698