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: 10-01-17 and 12-31-17 Date of Report: 02-03-18 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2084 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 13 13 17.271429 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 13 13 17.271429 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 1.000000 $48.5000 $48.5000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 5.428571 $678.5800 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 4 4 4.073973 $203.7000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 73 90 89.541550 $4477.0900 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 0.009590 $0.7100 $74.3000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 5 5 2.017808 $151.3400 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 0.008220 $0.6200 $74.8200
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 3 3 3.001370 $166.5800 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 50 50 2.202745 $165.1700 $74.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 5 5 4.015068 $301.1300 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 45 45 10.146582 $760.9400 $74.9900
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 67 67 9.223300 $511.8300 $55.4900
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 31 31 2.104115 $157.7600 $74.9700
OCTH -97166 OT EVAL MODERATE COMPLEXITY 12 12 4.427398 $226.0200 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 44 44 14.550458 $742.8100 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.134247 $6.8500 $51.0300
PSTH -97162 PT EVAL MODERATE COMPLEXITY 6 7 2.010959 $102.6600 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 38 38 9.666146 $493.4600 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.046575 $2.3800 $51.0800
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 69 69 24.419861 $1246.6500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 18 18 8.175343 $417.3500 $51.0500
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Subtotal (Total Children Is Unduplicated) 356 497 196.203879 $10862.1100 $55.3600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 14 14 16.029344 $80146.5000 $4999.9900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 7 7 6.850000 $342.5000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 301 336 453.387692 $22669.3700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.002740 $0.0700 $24.6400
CONOF -CONOF CONSULT, OT, FACE TO FACE 85 91 108.143256 $5407.1700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 119 126 161.134006 $8056.6900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 236 264 343.032697 $17151.6200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.800000 $20.0000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 45 63 279.057148 $6976.4200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 289 319 1655.444442 $82772.2700 $50.0000
INTR -T1013 INTERPRETER 10 11 91.319046 $4565.9500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 69 76 402.678570 $28767.3700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 3.071429 $175.6800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 79 83 398.121435 $28441.7400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 2.357143 $134.7300 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 158 173 891.250003 $63670.9600 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 19.071429 $264.7100 $13.8800
TRAV -TRAVS Travel by mile 3 3 77.000000 $34.2700 $0.4500
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Subtotal (Total Children Is Unduplicated) 394 1574 4908.750380 $349598.0100 $71.2200
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Total 2084 5122.225688 $360460.1100 $70.3700
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Number of Children (Unduplicated) With at Least One Authorization 578