Summary Report for FSPSAs Initiated During the Report Period Center: 05
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: 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 1398 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 10.338096 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 9 9 10.338096 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 35 46 49.798435 $2489.9200 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 4 3.208219 $240.6200 $75.0000
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 1 1 0.001370 $0.1100 $76.6400
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 4 4 0.012330 $0.9200 $74.2100
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 3 3 2.057535 $154.3100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 19 20 14.658906 $813.5500 $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 33 33 1.097268 $60.8400 $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 3 3 8.433268 $430.5200 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 43 43 29.920158 $1527.4300 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 35 35 17.686300 $902.9000 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 1.156164 $59.0200 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 4 4 3.049315 $155.6700 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 51 51 22.991933 $1173.7400 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 2 2 2.000000 $102.1000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 5 5 15.285715 $748.0800 $48.9400
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Subtotal (Total Children Is Unduplicated) 216 362 175.698039 $9161.1400 $52.1400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 10 10 9.191781 $45959.0000 $5000.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 15 16 6.278388 $313.9100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.233333 $30.8300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 192 210 234.304155 $11715.1900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 5 5 17.514286 $437.8600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 72 78 86.448338 $4322.4000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 75 77 77.638886 $3881.9300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 4.333333 $108.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 136 148 139.979719 $6998.9600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 7.000000 $175.0000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 13 14 99.142857 $2478.5700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 206 224 1338.800017 $66939.9800 $50.0000
INTR -T1013 INTERPRETER 6 7 53.223810 $2661.2000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 50 51 235.902384 $16852.8800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 15.142857 $866.1700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 52 54 341.900002 $24425.3400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 4 4 25.285715 $1445.3300 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 101 105 575.900989 $41142.3300 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 13 14 111.428572 $1546.6300 $13.8800
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Subtotal (Total Children Is Unduplicated) 297 1027 3380.649422 $232301.8300 $68.7200
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Total 1398 3566.685557 $241462.9700 $67.7000
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Number of Children (Unduplicated) With at Least One Authorization 360