Summary Report for FSPSAs Initiated During the Report Period Center: 05
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 2773 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 14 14 14.158728 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 4 4 16.758731 $620.0700 $37.0000
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Subtotal (Total Children Is Unduplicated) 18 18 30.917459 $620.0700 $20.0600
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 28 28 46.000000 $2300.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 4 4 6.460274 $484.5200 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 23 24 19.050685 $1428.7900 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 1.000000 $75.0000 $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 8 8 12.179452 $913.4600 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 2 2 3.000000 $225.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 15 17 4.293154 $321.9500 $74.9900
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 74 76 43.229557 $2399.1900 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 6 6 4.010960 $222.6000 $55.5000
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 121 121 1.952068 $108.2200 $55.4400
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 21 21 0.358909 $26.8700 $74.8500
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 9 9 5.509056 $281.2300 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 42 42 22.820243 $1164.9700 $51.0500
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 0.116667 $5.9600 $51.0600
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 3 1.738889 $88.7700 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 33 33 17.854111 $911.4700 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.0500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 2.000000 $102.1000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 99 100 87.519113 $4467.8500 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.183333 $9.3600 $51.0400
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.208219 $10.6300 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 11 11 9.977626 $444.5100 $44.5500
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Subtotal (Total Children Is Unduplicated) 399 682 294.121246 $16293.6800 $55.4000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 13 13 10.048478 $50242.5000 $5000.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 23 23 14.463409 $723.1800 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 2 2 0.900000 $45.0000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 330 347 397.622612 $19881.0900 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 17 17 7.512698 $375.6300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 5.566667 $139.1700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 111 113 110.832534 $5541.6100 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 2 2 0.919047 $45.9500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 4.466667 $111.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 127 132 227.990760 $11399.5200 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 6 6 2.055556 $102.7800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 269 286 285.835309 $14291.7200 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 11 11 2.361111 $118.0600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 4.705555 $117.6400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 10 10 73.714286 $1842.8600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 332 353 2175.904768 $108795.2200 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 134 136 286.117460 $14305.9100 $50.0000
INTR -T1013 INTERPRETER 4 4 12.185715 $609.2900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 72 79 404.678575 $28910.2500 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 36 37 67.490478 $4821.5200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 6 6 31.535714 $1803.8500 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 8.000000 $457.6000 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 0.571429 $40.8200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 84 89 584.776190 $41776.4200 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 30 31 43.619047 $3116.1700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 4 4 23.142857 $1322.8500 $57.1600
PHY -97110TLGT PT SESSION BY LICENSED PT 2 2 5.428571 $387.8200 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 197 204 1197.684132 $85562.5700 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 75 77 124.928569 $8924.9500 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 10 10 6.785713 $484.7800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 13 13 73.714287 $1023.1500 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 47 56 47.319050 $1750.8100 $37.0000
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Subtotal (Total Children Is Unduplicated) 566 2073 6242.877244 $409072.3300 $65.5300
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Total 2773 6567.915949 $425986.0800 $64.8600
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Number of Children (Unduplicated) With at Least One Authorization 672