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
Eligibility Filter: Program Patients
With the filters selected there were 2620 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 13 13 11.984126 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 13 13 11.984126 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 25 35 53.460731 $2673.0300 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 4 4 2.931507 $219.8600 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 28 29 30.050685 $2253.7900 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 4 4 4.179452 $313.4600 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 17 19 6.648482 $498.6000 $74.9900
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 78 80 49.023240 $2720.7400 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 4 4 0.010960 $0.6000 $54.6700
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 102 107 0.412347 $30.8000 $74.7000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 3 3 0.013699 $1.0300 $75.0100
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 56 56 0.224665 $16.8000 $74.7800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 120 120 0.452068 $24.9700 $55.2400
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 0.005479 $0.3100 $55.7000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 19 19 0.057539 $4.2700 $74.1700
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 0.002740 $0.2000 $73.9100
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 6 6 3.498324 $178.5900 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 67 68 42.540867 $2171.7200 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 4 4 2.666666 $136.1300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 47 48 39.005806 $1991.2600 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 3 3 2.095890 $107.0000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 6 6 5.139726 $262.3800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 100 101 65.252108 $3331.1100 $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 10 10 19.647750 $875.3100 $44.5500
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Subtotal (Total Children Is Unduplicated) 478 733 334.320731 $18265.0900 $54.6300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 26 26 23.408220 $117041.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 31 31 17.241185 $862.0600 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 1 1 0.500000 $25.0000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 323 343 368.392600 $18419.6500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 0.300000 $7.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 138 142 139.057884 $6952.8700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 2.800000 $70.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 128 132 135.843546 $6792.2000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 264 287 300.916721 $15045.8300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.133333 $28.3300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 18 18 102.285715 $2557.1400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 357 387 2314.576176 $115728.8400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 4 4 21.142857 $1057.1500 $50.0000
INTR -T1013 INTERPRETER 8 9 43.328572 $2166.4300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 99 104 730.433890 $52182.2000 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 2.214286 $158.1900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 4 4 23.142857 $1323.7700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 108 113 637.361902 $45533.1600 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 2 2 1.409524 $100.7000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 8 8 31.714285 $1812.7900 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 208 226 1366.892856 $97650.8200 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 5 5 10.571429 $755.2200 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 24 24 207.642856 $2882.0800 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 2 2 0.785714 $29.0700 $37.0000
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Subtotal (Total Children Is Unduplicated) 521 1874 6483.096408 $489182.0000 $75.4500
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Total 2620 6829.401265 $507447.0900 $74.3000
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Number of Children (Unduplicated) With at Least One Authorization 727