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
Eligibility Filter: Program Patients
With the filters selected there were 2402 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 10 10 13.955555 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 10 10 13.955555 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 62 80 85.450164 $4272.5100 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 4 4 0.504110 $37.8100 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 9 9 4.183563 $313.7600 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 3 3 1.002740 $75.2100 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 9 9 2.108221 $158.1100 $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 39 41 37.420161 $2076.7800 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 78 78 0.282208 $21.0500 $74.5700
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 9 9 0.034247 $2.5600 $74.6800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 107 107 0.458933 $34.2800 $74.6800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 100 100 1.463036 $81.0600 $55.4100
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 31 31 0.106860 $7.9600 $74.4700
OCTH -97166 OT EVAL MODERATE COMPLEXITY 11 11 14.065156 $718.0300 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 58 59 19.225264 $981.4500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 1.411111 $72.0400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 45 46 15.717221 $802.3800 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.005479 $0.2800 $51.2500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 2.000000 $102.1000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 95 95 44.702774 $2282.0900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 5 5 5.000000 $255.2500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 9 9 5.410959 $264.8100 $48.9400
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Subtotal (Total Children Is Unduplicated) 486 705 244.554947 $12859.7100 $52.5800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 20 21 16.307002 $81535.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 19 21 9.716202 $485.7900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 1.234703 $30.8700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 299 325 358.846835 $17942.3800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.666667 $16.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 121 126 121.889683 $6094.4900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.466667 $11.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 126 136 121.588459 $6079.4200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.533333 $13.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 237 261 268.203168 $13410.1600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 6 7.509523 $187.7400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 29 37 178.999993 $4475.0100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 305 329 1801.077761 $90054.0000 $50.0000
INTR -T1013 INTERPRETER 3 3 31.428571 $1571.4300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 92 99 558.882888 $39926.6200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 10 10 75.428573 $4314.5100 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 82 86 426.871429 $30495.7200 $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 195 205 1156.400003 $82613.2500 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 14 14 77.821427 $1080.1600 $13.8800
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Subtotal (Total Children Is Unduplicated) 439 1687 5232.301459 $381391.6000 $72.8900
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Total 2402 5490.811961 $394251.3000 $71.8000
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Number of Children (Unduplicated) With at Least One Authorization 701