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: 10-01-18 and 12-31-18 Date of Report: 02-05-19 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2706 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 3 3 0.577169 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 3 3 0.577169 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 40 43 24.101956 $1168.9500 $48.5000
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 1.000000 $51.0700 $51.0700
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 0.488889 $24.4500 $50.0000
EXIT -EXIT EXIT ASSESSMENT 42 42 45.325875 $2266.3000 $50.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 14 14 20.021916 $1501.6500 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 13 13 24.005479 $1800.4100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 37 37 55.549311 $3083.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 31 31 57.510958 $4313.3300 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.024658 $1.2600 $51.1400
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.241096 $12.3100 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 4 4 1.638889 $83.6700 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.241096 $12.3100 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 6 6 2.866668 $146.3500 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 2.000000 $102.1000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 0.738280 $37.6900 $51.0400
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Subtotal (Total Children Is Unduplicated) 152 200 237.755071 $14715.8200 $61.8900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 8 10 14.560405 $72802.5000 $5000.0300
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 58 62 43.291364 $2164.5600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 0.005518 $0.1400 $24.9200
CONIF -CONIF CONSULT, ITDS FACE TO FACE 264 298 537.020770 $26851.0100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 6 6 9.002381 $225.0600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 105 106 139.798414 $6989.9300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.283333 $7.0800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 31 31 37.288890 $1864.4500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.166667 $4.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 200 205 358.764280 $17938.1900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.250000 $6.2500 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 3.857143 $282.8000 $73.3200
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 59 62 348.400004 $17420.0000 $50.0000
INTR -T1013 INTERPRETER 21 31 63.826615 $3191.3300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 379 587 2200.404153 $22004.0200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 17 17 79.785716 $5699.8800 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 17 17 100.238097 $7161.0100 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 8 8 52.000001 $3714.8700 $71.4400
TRAV -TRAVS Travel by mile 549 1057 175462.003145 $78080.5900 $0.4500
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Subtotal (Total Children Is Unduplicated) 567 2503 179450.946896 $266407.8500 $1.4800
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Total 2706 179689.279136 $281123.6700 $1.5600
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Number of Children (Unduplicated) With at Least One Authorization 584