Summary Report for FSPSAs Initiated During the Report Period Center: 05
This report shows the total number of units/fees for FSPSAs initiated during the report period.
(i.e., start 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 starting 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 2006 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 4 4 3.238095 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 4 4 3.238095 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EVAL -96111 DEVELOPMENTAL EVALUATION 5 5 5.073973 $253.7000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 57 65 63.304369 $3165.2300 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 0.006850 $0.5100 $74.4500
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 4 4 2.015068 $151.1300 $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 47 47 12.772609 $957.8900 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 69 69 12.223300 $678.3300 $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 14 14 3.904109 $199.3000 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 38 38 12.460731 $636.1200 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 4 4 3.087671 $157.6300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 37 38 14.181975 $724.0000 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.030137 $1.5400 $50.9900
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.189041 $9.6500 $51.0400
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 76 76 31.654797 $1616.0000 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 27 27 5.785616 $295.3500 $51.0500
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Subtotal (Total Children Is Unduplicated) 301 482 178.021764 $9637.6200 $54.1400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 15 15 8.258143 $41291.0000 $5000.0300
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 9 9 10.601587 $530.0800 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 309 325 737.067856 $36853.3900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.533333 $13.3300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 85 85 123.410943 $6170.5700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 4.033333 $100.8300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 123 129 186.550209 $9327.5300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 235 252 337.833312 $16891.7000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.833333 $20.8300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 53 61 396.361910 $9909.0500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 293 304 1944.146054 $97207.2300 $50.0000
INTR -T1013 INTERPRETER 9 11 120.714286 $6035.7100 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 65 65 472.857146 $33780.9200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 8.071428 $461.6900 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 72 75 569.134132 $40658.9600 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 3 9.233333 $527.7800 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 157 166 1110.247629 $79316.0200 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 0.785714 $44.9400 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 10 10 80.500000 $1117.3400 $13.8800
TRAV -TRAVS Travel by mile 3 3 77.000000 $34.2700 $0.4500
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Subtotal (Total Children Is Unduplicated) 439 1520 6198.173681 $380293.1500 $61.3600
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Total 2006 6379.433540 $389930.7700 $61.1200
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Number of Children (Unduplicated) With at Least One Authorization 515