Summary Report for FSPSAs Ending During the Report Period Center: 05
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: 07-01-19 and 09-30-19 Date of Report: 11-04-19 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1417 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 9 9 11.955555 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 9 9 11.955555 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 36 46 49.304763 $2465.2400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 2 0.293151 $21.9800 $74.9900
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 6 6 3.009590 $225.7100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 1.001370 $75.1100 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 6 6 2.012330 $150.9200 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 4 4 4.002740 $300.2000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 26 27 33.159884 $1840.3600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 28 28 0.078090 $5.7800 $73.9500
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 5 5 0.016439 $1.2200 $74.3700
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 56 56 0.205494 $15.3300 $74.6000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 34 34 1.127405 $62.5100 $55.4400
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 10 10 0.031510 $2.3400 $74.2600
OCTH -97166 OT EVAL MODERATE COMPLEXITY 9 9 13.015156 $664.4300 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 34 35 7.738658 $395.0700 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 1.411111 $72.0400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 29 30 8.635029 $440.8300 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.005479 $0.2800 $51.2500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 57 57 29.169213 $1489.0900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 3 3 3.000000 $153.1500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 8 8 5.306849 $259.7200 $48.9400
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Subtotal (Total Children Is Unduplicated) 266 371 162.524261 $8641.2800 $53.1700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 8 8 5.356165 $26781.0000 $5000.0300
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 14 15 6.587434 $329.3600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.233333 $30.8300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 195 213 223.453973 $11172.7200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.666667 $16.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 66 69 60.843258 $3042.1900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.466667 $11.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 87 95 80.571203 $4028.5700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.533333 $13.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 137 153 161.702166 $8085.1200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 6.366666 $159.1700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 17 23 104.714282 $2617.8700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 203 222 1171.685703 $58584.3500 $50.0000
INTR -T1013 INTERPRETER 3 3 31.428571 $1571.4300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 44 47 273.531746 $19541.1200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 5 5 32.357144 $1850.8300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 53 55 235.014286 $16789.4500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 3 18.428572 $1053.3800 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 102 110 649.897623 $46428.7000 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 7 7 42.571427 $590.8900 $13.8800
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Subtotal (Total Children Is Unduplicated) 264 1037 3107.410219 $202698.6300 $65.2300
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Total 1417 3281.890035 $211339.9100 $64.4000
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Number of Children (Unduplicated) With at Least One Authorization 396