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 1403 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 58 79 87.365102 $4368.2600 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 0.104110 $7.8100 $74.9900
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 5 5 1.279453 $95.9600 $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 2 2 0.005480 $0.4100 $75.2700
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 20 21 10.042470 $557.3300 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 51 51 0.208228 $15.5800 $74.8100
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 5 5 0.023287 $1.7500 $75.0400
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 53 53 0.198645 $14.8300 $74.6400
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 68 68 0.246591 $13.6100 $55.1800
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 21 21 0.075350 $5.6200 $74.5500
OCTH -97167 OT EVAL HIGH COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 2 1.038356 $53.0100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 7 7 4.178082 $213.2900 $51.0500
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Subtotal (Total Children Is Unduplicated) 205 319 106.767894 $5449.7600 $51.0400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 12 12 10.643988 $53220.0000 $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 303 329 356.776487 $17838.8400 $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 235 258 245.481309 $12274.0500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 9 9 15.300001 $382.5000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 9 11 60.085715 $1502.1500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 112 117 768.853974 $38442.6900 $50.0000
INTR -T1013 INTERPRETER 6 6 49.509524 $2475.4800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 5 6 32.214286 $2301.3800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 5.714286 $326.8600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 6 7 40.500001 $2893.3100 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 18 19 133.142858 $9511.7100 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 12.285715 $170.5300 $13.8800
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Subtotal (Total Children Is Unduplicated) 404 1069 2034.985639 $155888.1900 $76.6000
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Total 1403 2156.136073 $161337.9500 $74.8300
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Number of Children (Unduplicated) With at Least One Authorization 514