Summary Report for FSPSAs Initiated During the Report Period Center: 02
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: 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 2873 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 3 3 2.008675 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 3 3 2.008675 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 31 34 19.220091 $932.1800 $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 1.000000 $23.7000 $23.7000
EXIT -EXIT EXIT ASSESSMENT 69 69 66.224658 $3311.2400 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 21 21 34.516437 $2588.7400 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 19 19 31.015068 $2326.1300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 55 55 88.047942 $4886.6700 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 20 20 38.005479 $2850.4100 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 0.477778 $24.3900 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.116667 $5.9600 $51.0600
OCTH -97166 OT EVAL MODERATE COMPLEXITY 4 4 0.487671 $24.8900 $51.0400
OCTH -97167 OT EVAL HIGH COMPLEXITY 3 3 2.213699 $113.0100 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 5 6 2.788890 $142.3800 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.788889 $40.2700 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 3 0.367123 $18.7400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.116667 $5.9600 $51.0600
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 12 12 5.141704 $262.4800 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.128767 $6.5800 $51.0600
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 178 254 292.657530 $17628.6400 $60.2400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 10 4.868493 $24343.0000 $5000.1100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 79 83 85.964135 $4298.1800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 0.900000 $22.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 257 275 528.476550 $26423.8200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 136 140 237.333331 $11866.6500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.433333 $10.8300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 25 25 42.599999 $2130.0000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 234 236 375.000005 $18750.0300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 3.666667 $91.6700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 71 73 443.952386 $22197.6300 $50.0000
INTR -T1013 INTERPRETER 26 49 94.390998 $4719.5500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 322 603 2211.645747 $22116.4500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 12 12 83.888096 $5992.9800 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 10 10 70.683333 $5049.6200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 8.571429 $489.9400 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 16 16 113.547619 $8111.8500 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 2.285714 $31.7300 $13.8800
TRAV -TRAVS Travel by mile 424 1078 164893.419790 $73377.5700 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 454 2616 169201.627625 $230023.9900 $1.3600
-------------------------------------------------------------------------------------------------------------------------------------
Total 2873 169496.293830 $247652.6300 $1.4600
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 482