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 1420 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 18 27 40.460731 $2023.0300 $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 13 14 10.039725 $752.9800 $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 3 3 2.179452 $163.4600 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 7 8 2.279454 $170.9400 $74.9900
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 48 49 25.673976 $1424.8800 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 1 0.002740 $0.1500 $54.6700
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 53 56 0.245209 $18.3800 $74.9400
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 26 26 0.109593 $8.2100 $74.8700
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 59 59 0.271231 $15.0500 $55.4900
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 10 10 0.032879 $2.4500 $74.3600
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 0.002740 $0.2000 $73.9100
OCTH -97167 OT EVAL HIGH COMPLEXITY 4 4 2.302816 $117.5600 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 2 1.210959 $61.8200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 7 7 4.526027 $231.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 182 277 96.288217 $5511.3500 $57.2400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 8 8 7.172603 $35863.0000 $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 322 342 367.159267 $18357.9800 $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 262 284 299.077832 $14953.8800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.133333 $28.3300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 6 6 44.000001 $1100.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 125 131 768.003170 $38400.1400 $50.0000
INTR -T1013 INTERPRETER 8 9 43.328572 $2166.4300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 7 7 26.714286 $1908.4600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 8 8 42.928571 $3066.8100 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 20 20 119.857144 $8562.5900 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 15.428572 $214.1500 $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) 426 1130 2031.331680 $139360.4600 $68.6100
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Total 1420 2139.604023 $144871.8000 $67.7100
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Number of Children (Unduplicated) With at Least One Authorization 536