Summary Report for FSPSAs Ending During the Report Period Center: 05
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: 10-01-16 and 12-31-16 Date of Report: 02-04-17 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 991 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 8 8 18.447619 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 8 8 18.447619 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EVAL -96111 DEVELOPMENTAL EVALUATION 2 2 1.038356 $51.9200 $50.0000
EXIT -EXIT EXIT ASSESSMENT 63 67 71.717114 $3585.8800 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 9.785714 $733.9300 $75.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 6 6 3.758219 $281.8700 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 2 2 1.700000 $127.5000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 6 6 3.074887 $230.6100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 23 23 16.182193 $898.1100 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.133333 $160.0000 $75.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 4 4 1.331508 $67.9800 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 0.216438 $11.0500 $51.0400
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 0.232877 $11.8900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 1 1 0.052055 $2.6600 $51.0900
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 109 117 111.222694 $6163.3800 $55.4100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.041096 $205.5000 $5000.4900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 32 43 29.176982 $1458.8400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 0.522222 $13.0600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 244 303 344.034100 $17201.6900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 3 4.339682 $108.4900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 49 54 59.868828 $2993.4500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 88 90 85.551582 $4277.5600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 147 161 173.203413 $8660.1700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 2.333333 $58.3300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 14 20 111.123810 $2778.0900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 112 125 576.184295 $28809.2000 $50.0000
INTR -T1013 INTERPRETER 8 9 86.428572 $4321.4200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 0.428571 $30.6200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 8 8 22.159524 $1583.0800 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 4.000000 $228.6400 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 13 13 71.214284 $5087.5600 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 4.428571 $61.4700 $13.8800
TRAV -TRAVS Travel by mile 26 29 5523.100000 $2457.7800 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 316 866 7098.138865 $80334.9300 $11.3200
-------------------------------------------------------------------------------------------------------------------------------------
Total 991 7227.809178 $86498.3100 $11.9700
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 365