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 1216 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
----------------------------------------------------------------------------
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 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 26 26 5.212332 $390.9000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 41 41 8.131513 $451.2600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 10 10 0.043836 $3.2900 $74.9400
OCTH -97167 OT EVAL HIGH COMPLEXITY 4 4 2.219178 $113.2900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 3 3 2.005479 $102.3800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 1 1 0.090411 $4.6100 $51.0400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 148 202 94.255070 $5015.2200 $53.2100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.000000 $10000.0000 $5000.0000
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 34 39 248.076193 $6201.9100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 115 117 770.304765 $38515.2200 $50.0000
INTR -T1013 INTERPRETER 9 11 120.714286 $6035.7100 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 4 26.178571 $1870.2000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 5 6 36.285714 $2592.2500 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 23 23 140.642858 $10047.5100 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 13.142857 $182.4200 $13.8800
TRAV -TRAVS Travel by mile 3 3 77.000000 $34.2700 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 372 1010 2835.209150 $145387.7300 $51.2800
-------------------------------------------------------------------------------------------------------------------------------------
Total 1216 2932.702315 $150402.9400 $51.2800
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 430