Summary Report for FSPSAs Initiated During the Report Period Center: 55
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 1857 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 19 19 22.514286 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 4 4 1672.000000 $61864.0000 $37.0000
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Subtotal (Total Children Is Unduplicated) 22 23 1694.514286 $61864.0000 $36.5100
Screening, Eval, and Assessment, Class # 02
EVAL -96111 DEVELOPMENTAL EVALUATION 24 28 28.171462 $1408.5900 $50.0000
EXIT -EXIT EXIT ASSESSMENT 57 57 95.000001 $4750.0100 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 18 18 36.000000 $2700.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 16 16 30.285714 $2271.4300 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 8 8 16.000000 $1200.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 11 11 18.291193 $1015.1600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 3 3 6.000000 $450.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 4 4 0.727778 $37.1500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 7 8 7.611904 $388.5900 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.411111 $20.9900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 13 13 5.872223 $299.7800 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.377778 $16.8300 $44.5500
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Subtotal (Total Children Is Unduplicated) 128 170 246.749164 $14660.6200 $59.4200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.344444 $1722.0000 $4999.3600
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.455556 $22.7800 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 16 17 15.509921 $775.5000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 0.716667 $17.9200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 235 247 179.142058 $8957.0800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 221 240 256.177784 $6404.4500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 140 257 140.266663 $7013.3200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 89 157 154.877782 $3871.9600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 34 61 31.905552 $1595.2600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 21 42 33.211111 $830.2800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 209 218 153.642058 $7682.0800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 216 229 239.350799 $5983.7800 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 3 3 15.714285 $392.8600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 63 67 429.585716 $21479.2800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 12 12 11.142857 $557.1500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 9 9 46.714287 $3337.2700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 11 11 54.571429 $3121.4800 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 2 2 4.285714 $245.1400 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 5 6 31.857143 $2275.8800 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 1.000000 $71.4400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 4 4 37.142857 $2123.0900 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 20 20 110.000002 $7858.3900 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 5 5 4.714286 $336.7900 $71.4400
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 42 52 50.199998 $1857.4300 $37.0000
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Subtotal (Total Children Is Unduplicated) 422 1664 2002.528969 $88532.5700 $44.2100
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Total 1857 3943.792419 $165057.1900 $41.8500
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Number of Children (Unduplicated) With at Least One Authorization 500