Summary Report for FSPSAs Ending During the Report Period Center: 02
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: 01-01-18 and 03-31-18 Date of Report: 05-05-18 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2427 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 1 1 1.300000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 1.300000 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 29 33 17.777658 $862.2100 $48.5000
EXIT -EXIT EXIT ASSESSMENT 68 69 90.344750 $4517.2300 $50.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 5 5 8.002740 $444.1500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 9 9 16.005479 $1200.4100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 17 17 28.016437 $1554.9200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 19 19 37.500000 $2812.5000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 0.174049 $8.8900 $51.0600
OCTH -97166 OT EVAL MODERATE COMPLEXITY 2 3 0.241096 $12.3100 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 4 4 0.821386 $41.9300 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 5 5 0.655860 $33.4800 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 4 0.326028 $16.6400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 2 0.339803 $17.3500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.073973 $3.7800 $51.0700
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 7 9 1.836455 $93.7500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 2 2 0.216439 $11.0500 $51.0400
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Subtotal (Total Children Is Unduplicated) 141 190 214.332153 $12530.6000 $58.4600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 8 9 2.212861 $11063.5000 $4999.6400
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 70 76 43.962548 $2198.0900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 1.255556 $31.3900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 223 268 368.471783 $18423.5700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.833333 $45.8300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 86 91 127.066667 $6353.3400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 30 31 45.966667 $2298.3400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 166 179 246.499996 $12324.9800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.833333 $45.8300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 49 51 271.138097 $13556.9000 $50.0000
INTR -T1013 INTERPRETER 28 42 76.738161 $3836.9100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 323 509 1775.345265 $17753.4400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 11 11 73.142859 $5225.3300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 13 14 76.857143 $5490.6800 $71.4400
SENS -V5264 EARMOLD 1 1 0.711111 $12.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 17 19 104.857144 $7490.9900 $71.4400
TRAV -TRAVS Travel by mile 478 931 144234.144305 $64184.2000 $0.4500
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Subtotal (Total Children Is Unduplicated) 487 2236 147452.036829 $170336.1000 $1.1600
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Total 2427 147667.668982 $182866.6900 $1.2400
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Number of Children (Unduplicated) With at Least One Authorization 497