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 2771 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 31 34 21.392011 $1037.5200 $48.5000
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 1 1 0.005479 $0.4100 $75.2900
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 0.005479 $0.4100 $75.2900
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 0.010958 $0.6100 $55.7000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 13 13 22.010958 $1650.8300 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 5 5 8.002740 $600.2000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 32 32 53.524656 $2970.6200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 12 12 24.000000 $1800.0000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.112329 $5.7300 $51.0400
OCTH -97167 OT EVAL HIGH COMPLEXITY 2 2 1.098630 $56.0800 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 2 0.316666 $16.1600 $51.0400
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 2 1.327778 $67.7800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 5 6 3.257534 $166.3000 $51.0500
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Subtotal (Total Children Is Unduplicated) 149 184 217.207683 $12429.2900 $57.2200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 8 9 5.178083 $25890.5000 $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 274 302 491.957139 $24597.8500 $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 76 83 421.052384 $21052.6200 $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 10 10 44.564285 $3183.6700 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 7 7 45.785713 $3270.9300 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 7 8 45.000000 $3214.8100 $71.4400
TRAV -TRAVS Travel by mile 478 995 158224.076221 $70409.7200 $0.4500
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Subtotal (Total Children Is Unduplicated) 512 2584 162340.486714 $214134.6400 $1.3200
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Total 2771 162559.015401 $226563.9300 $1.3900
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Number of Children (Unduplicated) With at Least One Authorization 521