Summary Report for FSPSAs Ending During the Report Period Center: 02
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: 01-01-20 and 03-31-20 Date of Report: 05-15-20 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 3566 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 1.321004 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 3 3 1.321004 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 40 43 27.590185 $1338.1300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.054795 $3.1000 $56.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 2.000000 $47.4000 $23.7000
EXIT -EXIT EXIT ASSESSMENT 67 67 78.142465 $3907.1300 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 4 4 4.010958 $300.8300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 0.005479 $0.4100 $75.2900
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 6 6 6.016437 $333.9200 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 97 97 161.084925 $12081.3900 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 33 33 46.052051 $3453.9200 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 124 126 199.636977 $11079.8700 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 50 50 95.504110 $7162.8100 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 4.000000 $300.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 4 4 2.256349 $115.1900 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 1.100000 $56.1600 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 9 10 2.907078 $148.4100 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 19 20 11.158828 $569.6600 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 7 7 1.238889 $63.2500 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 0.483333 $24.6700 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 8 8 3.897337 $198.9600 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 18 18 11.400457 $582.0000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.147945 $7.5500 $51.0300
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 30 31 18.647640 $951.9600 $51.0500
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Subtotal (Total Children Is Unduplicated) 312 538 683.336238 $43098.7000 $63.0700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 50 53 32.329987 $161650.5000 $5000.0200
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 0.227397 $11.3700 $49.9800
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 77 84 88.925494 $4446.2700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 4 6 1.033332 $25.8300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 275 303 493.290472 $24664.5100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 1.166667 $29.1700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 144 148 218.847622 $10942.4000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.366667 $34.1700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 27 28 44.033335 $2201.6800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 246 259 382.895236 $19144.7600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 4.833333 $120.8300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 300 320 1887.799986 $94390.0800 $50.0000
INTR -T1013 INTERPRETER 20 30 59.065926 $2953.3100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 348 605 2260.477880 $22604.7900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 65 68 358.671425 $25623.5100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 12.142857 $694.5700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 54 55 362.642854 $25907.2100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 12.142857 $694.0900 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 55 58 380.714284 $27198.2700 $71.4400
TRAV -TRAVS Travel by mile 478 996 158566.933364 $70562.2900 $0.4500
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Subtotal (Total Children Is Unduplicated) 529 3025 165169.540975 $493899.5800 $2.9900
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Total 3566 165854.198217 $536998.2800 $3.2400
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Number of Children (Unduplicated) With at Least One Authorization 536