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 1424 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
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 20 21 29.620634 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 45 60 74.905807 $3745.2900 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 7 7 4.416437 $331.2400 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 13 13 4.108296 $308.1300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 3 3 2.004110 $150.3100 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 3 3 0.106850 $8.0100 $74.9600
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 3 3 0.008220 $0.6100 $73.9100
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 33 33 22.011552 $1221.6100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 53 53 0.220558 $16.5100 $74.8400
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 4 4 0.015069 $1.1300 $74.6600
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 49 49 0.200012 $14.9600 $74.8100
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 59 59 0.811166 $44.9900 $55.4600
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 25 25 0.080828 $6.0100 $74.3200
PSTH -97163 PT EVAL HIGH COMPLEXITY 3 3 2.169863 $110.7700 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 8 8 2.749315 $140.3500 $51.0500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 203 323 113.808083 $6099.9100 $53.6000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.000000 $10000.0000 $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 301 321 386.862602 $19343.1100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 7 7 14.965080 $374.1300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 115 118 218.611112 $10930.5500 $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 15 20 61.009520 $1525.2500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 110 114 689.266665 $34463.3500 $50.0000
INTR -T1013 INTERPRETER 11 11 59.619046 $2980.9500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 6 6 30.142857 $2153.4100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 31.857143 $1822.2300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 6 6 37.928572 $2709.6100 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 19 22 129.785714 $9271.8800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 8.714286 $120.9500 $13.8800
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 396 1080 2171.707888 $120181.0100 $55.3400
-------------------------------------------------------------------------------------------------------------------------------------
Total 1424 2315.136605 $126280.9200 $54.5500
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 539