Summary Report for FSPSAs Initiated During the Report Period Center: 02
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: 10-01-18 and 12-31-18 Date of Report: 02-05-19 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 3780 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 5.133333 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 3 3 5.133333 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 38 41 28.087335 $1362.2300 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.294444 $6.9800 $23.7000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 1.000000 $84.8400 $84.8400
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 2 2 29.000000 $1414.0400 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 0.022222 $1.1100 $49.9500
EXIT -EXIT EXIT ASSESSMENT 78 79 79.084933 $3954.2500 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 2.005479 $150.4100 $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 7 7 12.005479 $666.3100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 107 108 178.097253 $13357.3200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 57 57 95.546573 $7166.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 165 165 248.213684 $13775.9000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 97 97 167.568489 $12567.6500 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 1.227397 $62.6600 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 6 6 15.266417 $779.3500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 19 19 9.374808 $478.5800 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 7 7 2.022222 $103.2300 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 12 12 31.239923 $1594.8000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 26 26 10.384474 $530.1200 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 5 5 3.150001 $160.8100 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 0.200989 $10.2600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 22 23 10.894523 $556.1700 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 7 7 4.522222 $230.8600 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 5 5 1.737900 $85.0600 $48.9400
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Subtotal (Total Children Is Unduplicated) 361 680 940.946767 $59848.9400 $63.6100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 45 48 32.843194 $164215.5000 $4999.9900
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.049315 $3.5300 $71.5900
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 1.002740 $230.6200 $229.9900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 68 72 63.021921 $3151.1000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 3 1.538851 $38.4700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 278 302 523.663637 $26183.1900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 4.933334 $123.3400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 141 143 238.114284 $11905.7100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 5.300000 $132.5000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 23 23 45.366668 $2268.3400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 220 222 395.997619 $19799.8800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 3.166667 $79.1700 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 6 6 59.142858 $4336.3600 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 15 15 1328.428569 $33210.7100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 307 319 2159.052415 $107952.5000 $50.0000
INTR -T1013 INTERPRETER 22 33 83.826615 $4191.3300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 347 606 2760.765818 $27607.6200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 49 49 417.321434 $29813.4200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 63 63 502.403581 $35891.6700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 9.571429 $547.1000 $57.1600
SENS -V5264 EARMOLD 1 1 0.002740 $0.0500 $17.7400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 62 63 561.285723 $40098.2400 $71.4400
TRAV -TRAVS Travel by mile 430 1118 218793.610698 $97363.1600 $0.4500
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Subtotal (Total Children Is Unduplicated) 457 3097 227990.410110 $609143.4900 $2.6700
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Total 3780 228936.490210 $668992.4300 $2.9200
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Number of Children (Unduplicated) With at Least One Authorization 491