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 1475 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
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Subtotal (Total Children Is Unduplicated) 14 14 14.158728 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 17 17 25.000000 $1250.0000 $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 14 15 10.039725 $752.9800 $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 6 8 2.263015 $169.7100 $74.9900
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 45 46 20.427401 $1133.7000 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 2 2 2.002740 $111.1500 $55.5000
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 60 60 1.771231 $98.3000 $55.5000
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 -97166 OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 0.386302 $19.7200 $51.0500
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Subtotal (Total Children Is Unduplicated) 175 258 74.939739 $4466.1900 $59.6000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 3.076712 $15383.5000 $4999.9800
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 326 343 390.855945 $19542.7500 $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 268 285 284.135309 $14206.7200 $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 2 2 15.142857 $378.5700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 103 106 644.109523 $32205.4900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 55 55 106.988891 $5349.4500 $50.0000
INTR -T1013 INTERPRETER 4 4 12.185715 $609.2900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 7 9 23.571429 $1683.9300 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 2.285714 $163.2900 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 2 2 8.428571 $602.1400 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 2 2 5.428571 $387.8200 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 14 14 88.000000 $6286.7200 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 6 6 10.214285 $729.7100 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 1.142857 $81.6500 $71.4400
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 47 55 46.890479 $1734.9500 $37.0000
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Subtotal (Total Children Is Unduplicated) 467 1203 2024.230862 $118066.1700 $58.3300
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Total 1475 2113.329329 $122532.3700 $57.9800
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Number of Children (Unduplicated) With at Least One Authorization 535