Summary Report for FSPSAs Initiated During the Report Period Center: 02
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: 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 3229 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 1 1 0.222222 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 0.222222 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 42 48 46.286226 $2244.8900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $56.4900 $56.4900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.000000 $23.7000 $23.7000
EXIT -EXIT EXIT ASSESSMENT 68 68 72.468906 $3623.4500 $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 34 34 46.402736 $3480.2200 $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 6 6 8.666666 $442.4300 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.422222 $21.5500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 7 7 3.502435 $178.8000 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 27 27 18.185748 $928.3700 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 9 9 5.627777 $287.2900 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 6 6 5.191781 $265.0400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 20 20 10.898152 $556.3500 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.189041 $9.6500 $51.0400
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.235616 $12.0300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 30 32 21.624657 $1103.9400 $51.0500
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Subtotal (Total Children Is Unduplicated) 283 552 718.960849 $44916.4700 $62.4700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 50 56 45.466743 $227334.0000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.422222 $21.1100 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 73 79 85.523908 $4276.1900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 4 6 1.033332 $25.8300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 241 258 467.543944 $23377.2500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 129 129 261.242860 $13062.1500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.666667 $41.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 25 26 47.685716 $2384.3000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.666667 $41.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 219 224 355.871433 $17793.5900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 5.366668 $134.1700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 253 265 1736.771436 $86838.5000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 8 8 9.695238 $484.7700 $50.0000
INTR -T1013 INTERPRETER 20 30 60.518307 $3025.9200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 300 531 2110.573140 $21105.7100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 63 63 466.083333 $33296.9700 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 2.285714 $163.2900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 11.000000 $629.2000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 55 55 433.415475 $30963.1700 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 2 2 2.714285 $193.9100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 3 5.571429 $318.4600 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.208219 $47.4700 $227.9800
SENS -V5264 EARMOLD 1 1 0.624658 $11.2400 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 51 54 424.928574 $30356.8800 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 1.142857 $81.6500 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 5 5 30.428571 $422.3500 $13.8800
TRAV -TRAVS Travel by mile 344 869 143599.087291 $63901.6000 $0.4500
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Subtotal (Total Children Is Unduplicated) 395 2676 150168.538687 $560332.9900 $3.7300
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Total 3229 150887.721758 $605249.4600 $4.0100
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Number of Children (Unduplicated) With at Least One Authorization 421