Summary Report for FSPSAs Ending During the Report Period Center: 05
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
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1570 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 6 6 3.025397 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 6 6 3.025397 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 15 21 28.427398 $1421.3700 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 18 19 24.021918 $1801.6400 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 2.175342 $163.1500 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 13 15 6.637522 $497.7900 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 39 40 27.616388 $1532.6700 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 3 3 0.008220 $0.4500 $54.6700
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 52 54 0.179467 $13.3500 $74.3900
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 32 32 0.121922 $9.1100 $74.6800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 69 69 0.223300 $12.2800 $55.0200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 9 9 0.024660 $1.8200 $73.9100
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 3 3 2.025113 $103.3800 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 46 47 25.522525 $1302.9300 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 3 1.666666 $85.0800 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 37 38 33.501697 $1710.2700 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 1.095890 $55.9500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 3 3 2.139726 $109.2300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 69 70 46.163143 $2356.6300 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 1.000000 $51.0500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 7 7 18.483366 $823.4400 $44.5500
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Subtotal (Total Children Is Unduplicated) 293 441 225.034263 $12303.6800 $54.6700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 12 12 11.063014 $55315.0000 $4999.9900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 19 19 9.404046 $470.2100 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 207 221 232.803795 $11640.1900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 0.300000 $7.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 81 84 77.486856 $3874.3500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 2.800000 $70.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 87 89 98.467464 $4923.4000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 156 170 168.823468 $8441.1800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.233333 $5.8300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 12 12 58.285714 $1457.1500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 225 249 1454.787291 $72739.4200 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 4 4 21.142857 $1057.1500 $50.0000
INTR -T1013 INTERPRETER 7 8 42.328572 $2116.4300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 48 53 364.857146 $26065.4000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 3 3 19.714286 $1127.6600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 68 70 398.969044 $28502.3900 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 1.142857 $81.6500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 4 4 17.142857 $979.8900 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 95 104 600.999999 $42935.4400 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 3 9.571429 $683.7800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 12 12 89.500000 $1242.2600 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 0.285714 $10.5700 $37.0000
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Subtotal (Total Children Is Unduplicated) 307 1123 3680.109742 $263746.8100 $71.6700
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Total 1570 3908.169402 $276050.4900 $70.6300
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Number of Children (Unduplicated) With at Least One Authorization 435