Summary Report for FSPSAs Ending During the Report Period Center: 02
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: 10-01-19 and 12-31-19 Date of Report: 02-01-20 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 4023 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
CASE -CASE NON-TCM CASE MANAGEMENT 1 1 0.811111 $30.0100 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 3 3 1.939682 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.166667 $6.1700 $37.0100
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Subtotal (Total Children Is Unduplicated) 5 5 2.917460 $36.1800 $12.4000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 37 41 20.234397 $981.3600 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $13.8700 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.222222 $5.2700 $23.7000
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 1 1 3.285714 $160.2100 $48.7600
EXIT -EXIT EXIT ASSESSMENT 78 78 86.712327 $4335.6200 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 4 4 6.005479 $450.4100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 3 3 4.005479 $222.3100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 134 134 235.079447 $17630.9800 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 61 61 98.058900 $7354.4300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 192 192 323.435019 $17950.6700 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 67 67 129.510958 $9713.3300 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 3 3 0.238889 $12.2000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 4 4 0.424658 $21.6800 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 25 25 14.197869 $724.7900 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 10 10 2.798478 $142.8600 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 4 4 0.533333 $27.2300 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 6 6 2.370472 $121.0100 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 18 18 5.188889 $264.8900 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 3 3 1.049696 $53.5900 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 27 27 28.990998 $1479.9900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.416667 $21.2700 $51.0500
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Subtotal (Total Children Is Unduplicated) 386 687 969.759891 $62137.9600 $64.0800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 48 54 27.608598 $138042.5000 $4999.9800
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 73 77 70.163737 $3508.1600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 2.700000 $67.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 296 329 553.424168 $27671.2100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 6 6 11.666666 $291.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 156 161 254.771428 $12738.5700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 4.333333 $108.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 28 28 35.033331 $1751.6600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 253 262 394.490477 $19724.5300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 10.466667 $261.6700 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 3.285714 $240.9100 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 14 14 1534.285716 $38357.1400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 307 326 2008.133327 $100406.7000 $50.0000
INTR -T1013 INTERPRETER 26 45 66.590998 $3329.5500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 387 652 2383.458451 $23834.5900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 54 55 344.884348 $24638.5300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 8.000000 $457.6000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 55 55 344.535718 $24613.6300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 7.571428 $432.7900 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 53 55 381.265949 $27237.6200 $71.4400
TRAV -TRAVS Travel by mile 561 1198 180006.311837 $80102.8100 $0.4500
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Subtotal (Total Children Is Unduplicated) 600 3331 188452.981891 $527817.6300 $2.8000
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Total 4023 189425.659242 $589991.7800 $3.1100
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Number of Children (Unduplicated) With at Least One Authorization 617