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
Eligibility Filter: Program Patients
With the filters selected there were 2430 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 15 15 14.382540 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 15 15 14.382540 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 60 83 91.365102 $4568.2600 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 5 3.312329 $248.4200 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 10 10 4.287673 $321.5700 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 0.002740 $0.2100 $76.6400
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 6 6 0.017810 $1.3300 $74.5400
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 36 38 23.584937 $1308.9200 $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 106 106 0.393180 $29.3400 $74.6200
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 98 98 1.334269 $73.9200 $55.4000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 31 31 0.106860 $7.9600 $74.4700
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.000000 $50.0000 $50.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 6 6 9.645597 $492.4100 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 65 65 46.188194 $2357.9100 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 49 49 26.373971 $1346.4000 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 4 4 3.156164 $161.1200 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 9 9 7.139726 $364.4800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 80 80 39.644521 $2023.8600 $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 7 7 16.510373 $808.0200 $48.9400
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Subtotal (Total Children Is Unduplicated) 395 695 281.437436 $14597.2900 $51.8700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 25 25 22.835769 $114179.0000 $5000.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 27 29 16.329378 $816.4500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 1.234703 $30.8700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 304 330 358.609820 $17930.5000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 7 7 21.436509 $535.9200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 128 135 141.232465 $7061.6100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 110 117 119.911107 $5995.5400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 4.333333 $108.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 237 261 247.509087 $12375.4400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 9 9 15.300001 $382.5000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 21 24 152.657143 $3816.4300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 323 347 2142.353992 $107117.6600 $50.0000
INTR -T1013 INTERPRETER 6 7 53.223810 $2661.2000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 88 91 455.624239 $32549.8200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 5 5 29.142857 $1666.9700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 86 90 595.185720 $42520.0700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 7 7 47.714287 $2727.3400 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 197 207 1294.458139 $92476.0600 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 24 25 181.428573 $2518.2300 $13.8800
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Subtotal (Total Children Is Unduplicated) 503 1720 5900.520932 $447469.9200 $75.8400
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Total 2430 6196.340908 $462067.2100 $74.5700
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Number of Children (Unduplicated) With at Least One Authorization 630