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 1417 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 22 27 36.455251 $1822.7700 $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 16 16 12.042543 $903.2000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 5 5 6.004110 $450.3100 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 3 3 2.008220 $150.6200 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 4 4 0.090412 $6.7700 $74.9100
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 37 38 38.082786 $2113.5600 $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
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.122222 $6.2400 $51.0400
OCTH -97167 OT EVAL HIGH COMPLEXITY 4 4 1.204871 $61.5200 $51.0600
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 5 5 0.945206 $48.2600 $51.0600
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Subtotal (Total Children Is Unduplicated) 183 298 99.066815 $5705.5900 $57.5900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 3.194521 $15972.5000 $4999.9700
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 31 32 62.018256 $3100.9100 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 320 334 427.181348 $21359.0700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.461111 $11.5300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 121 123 154.122219 $7706.1000 $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 269 291 331.247615 $16562.3700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.000000 $25.0000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 8 10 95.000001 $2375.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 115 119 816.371427 $40818.5900 $50.0000
INTR -T1013 INTERPRETER 8 9 59.285715 $2964.2900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 6 6 27.000001 $1928.8700 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 6 7 38.428571 $2745.3300 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 15 21 135.714286 $9695.4200 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 10.714286 $148.7100 $13.8800
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Subtotal (Total Children Is Unduplicated) 416 1102 2386.324672 $136559.6100 $57.2300
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Total 1417 2503.939108 $142265.2000 $56.8200
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Number of Children (Unduplicated) With at Least One Authorization 512