Summary Report for FSPSAs Ending During the Report Period Center: 05
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 2506 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 20 21 29.620634 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 1.600000 $59.2000 $37.0000
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Subtotal (Total Children Is Unduplicated) 21 22 31.220634 $59.2000 $1.9000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 48 64 81.905807 $4095.2900 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 9 11 9.416437 $706.2400 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 23 23 5.152134 $386.3900 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 4 4 2.006850 $150.5100 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 7 7 0.121919 $9.1400 $74.9300
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 14 14 1.230140 $92.2300 $74.9700
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 62 62 38.088269 $2113.8300 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 91 91 0.327417 $24.4100 $74.5600
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 7 7 0.023289 $1.7300 $74.3900
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 113 113 0.445230 $33.2800 $74.7400
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 111 111 0.959125 $53.0900 $55.3500
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 50 51 0.152068 $11.2700 $74.1300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.000000 $50.0000 $50.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 4 4 2.488888 $127.0500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 53 53 41.395206 $2113.2300 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 3 3 3.000000 $153.1500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.083333 $4.2500 $51.0300
PSTH -97163 PT EVAL HIGH COMPLEXITY 39 40 29.079867 $1484.5300 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 10.142857 $517.8000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 4 4 2.284932 $116.6400 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 101 102 55.366115 $2826.4400 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.244444 $12.4800 $51.0400
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 9 9 17.785714 $870.4400 $48.9400
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Subtotal (Total Children Is Unduplicated) 521 778 302.700041 $15953.4200 $52.7000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 17 17 16.200000 $81000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 17 18 10.121920 $506.1000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 302 322 387.362602 $19368.1100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 7 7 14.965080 $374.1300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 116 120 221.644445 $11082.2200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.400000 $10.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 119 127 131.254207 $6562.7000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 4.400000 $110.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 260 290 337.102497 $16855.1400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 11 11 17.666667 $441.6700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 21 27 91.295234 $2282.3900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 299 318 1832.890467 $91644.5600 $50.0000
INTR -T1013 INTERPRETER 11 13 66.190475 $3309.5200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 85 88 592.590470 $42334.6900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 9 9 91.571429 $5237.8900 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 91 93 545.211899 $38949.9400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 6 6 22.363492 $1278.3000 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 209 224 1333.274812 $95249.1500 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 12 12 77.999999 $1082.6400 $13.8800
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Subtotal (Total Children Is Unduplicated) 452 1706 5794.505695 $417679.1300 $72.0800
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Total 2506 6128.426370 $433691.7500 $70.7700
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Number of Children (Unduplicated) With at Least One Authorization 744