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 2470 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 34 39 40.636911 $1970.8900 $48.5000
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 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
OCTF -97168 OT RE-EVAL EST PLAN CARE 2 2 7.455556 $380.6100 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 2 2 0.232876 $11.8900 $51.0600
OCTH -97167 OT EVAL HIGH COMPLEXITY 2 2 1.189041 $60.7000 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 4 4 3.683333 $188.0300 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 3 3 1.532040 $78.2100 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.189041 $9.6500 $51.0400
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 5 6 3.361643 $171.6100 $51.0500
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Subtotal (Total Children Is Unduplicated) 145 196 241.309617 $13643.9200 $56.5400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 15 17 14.328768 $71644.0000 $5000.0100
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 240 257 465.843944 $23292.2500 $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 61 64 368.138099 $18406.8800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 0.266667 $13.3400 $50.0100
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 14 14 94.790476 $6771.8300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 10 10 71.267857 $5091.3700 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 10 11 67.142858 $4796.6900 $71.4400
TRAV -TRAVS Travel by mile 344 868 143161.944434 $63707.0700 $0.4500
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Subtotal (Total Children Is Unduplicated) 387 2273 147174.871801 $255614.6000 $1.7400
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Total 2470 147416.403640 $269258.5200 $1.8300
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Number of Children (Unduplicated) With at Least One Authorization 412