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 1252 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
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 13 13 17.271429 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
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 1 1 0.004110 $0.3100 $74.8200
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 3 3 2.010958 $150.8300 $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 34 34 2.134253 $160.0400 $74.9900
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 3 3 0.015068 $1.1300 $75.1600
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 25 25 4.086305 $306.4500 $74.9900
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 39 39 5.131513 $284.7600 $55.4900
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 10 10 0.043836 $3.2900 $74.9400
OCTH -97167 OT EVAL HIGH COMPLEXITY 2 2 1.136986 $58.0400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 0.005479 $0.2800 $51.2500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 7 7 3.460274 $176.6500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 1 1 0.068493 $3.5000 $51.0500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 164 226 120.150959 $6671.8300 $55.5300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.000000 $10000.0000 $5000.0000
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 119 125 153.276863 $7663.8300 $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 26 32 176.700001 $4417.5000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 99 110 505.668253 $25283.4400 $50.0000
INTR -T1013 INTERPRETER 10 11 91.319046 $4565.9500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 5 5 21.571428 $1541.0600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 5 5 41.571428 $2969.8600 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 20 20 126.714286 $9052.4600 $71.4400
TRAV -TRAVS Travel by mile 3 3 77.000000 $34.2700 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 350 1013 2108.037690 $111119.0900 $52.7100
-------------------------------------------------------------------------------------------------------------------------------------
Total 1252 2245.460078 $117790.9200 $52.4600
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 446