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: 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 2581 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 17 17 18.547621 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 17 17 18.547621 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 26 31 43.455251 $2172.7700 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 5 5 0.783561 $58.7700 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 34 34 28.086381 $2106.4600 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 6 6 6.006850 $450.5100 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 7 7 2.023289 $151.7400 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 16 16 4.392850 $329.4300 $74.9900
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 69 70 59.886597 $3323.6400 $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 112 112 1.041317 $57.6500 $55.3600
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 50 51 0.152068 $11.2700 $74.1300
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 15 15 9.222373 $470.8000 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 61 61 30.511644 $1557.6100 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.0500 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 3 3 3.000000 $153.1500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 5 5 3.583333 $182.9300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 46 47 33.793022 $1725.1300 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.011111 $51.6200 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 5 5 4.250000 $216.9600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 120 123 62.863625 $3209.2100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 3 3 2.266667 $115.7200 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 13 13 9.993454 $489.0800 $48.9400
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Subtotal (Total Children Is Unduplicated) 437 821 309.119329 $16995.9600 $54.9800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 20 20 18.268494 $91342.5000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 31 32 62.018256 $3100.9100 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 321 335 429.781348 $21489.0700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.461111 $11.5300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 122 124 155.155552 $7757.7700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 3.333333 $83.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 135 141 221.251982 $11062.5900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 270 293 334.447615 $16722.3700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.000000 $25.0000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 16 20 186.571429 $4664.2900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 328 336 2292.795237 $114639.7500 $50.0000
INTR -T1013 INTERPRETER 10 11 65.857144 $3292.8600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 88 89 577.284920 $41241.2500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 3 3 2.766667 $158.2600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 102 104 684.309524 $48887.0500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 13 13 84.500000 $4830.0100 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 183 196 1246.913495 $89079.4800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 22 22 172.928574 $2400.2500 $13.8800
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Subtotal (Total Children Is Unduplicated) 500 1743 6539.644681 $460788.2400 $70.4600
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Total 2581 6867.311631 $477784.2000 $69.5700
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Number of Children (Unduplicated) With at Least One Authorization 647