Summary Report for FSPSAs Ending During the Report Period Center: 02
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: 04-01-20 and 06-30-20 Date of Report: 07-20-20 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 3104 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 3 3 13.285714 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 3 3 13.285714 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 49 54 29.685770 $1439.7600 $48.5000
EXIT -EXIT EXIT ASSESSMENT 68 68 69.639967 $3482.0000 $50.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 4.500000 $337.5000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 4.500000 $249.7500 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 26 26 52.000000 $3900.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 4 4 8.500000 $637.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 26 26 45.023286 $3376.7500 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 13 13 24.504110 $1837.8100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 79 80 158.455967 $8794.3100 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 9 9 18.000000 $999.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 18 18 42.000000 $3150.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 7 7 1.035237 $52.8500 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 3 3 1.522222 $77.7100 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 15 15 4.427399 $226.0200 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 20 21 11.300988 $576.9100 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 13 15 6.985237 $356.6000 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.244444 $12.4800 $51.0400
PSTH -97162 PT EVAL MODERATE COMPLEXITY 9 9 1.823212 $93.0700 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 27 28 15.671006 $800.0000 $51.0500
SCREEN-T1023 SCREENING 1 1 1.000000 $50.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 4 4 1.937519 $98.9100 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.126027 $6.4300 $51.0400
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 39 41 24.341609 $1242.6300 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.123288 $6.2900 $51.0600
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Subtotal (Total Children Is Unduplicated) 258 453 535.347288 $32326.2900 $60.3800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 61 67 46.440346 $232201.5000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 84 95 94.528670 $4726.4300 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 4 4 2.016666 $100.8300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 16 16 12.720835 $318.0300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 275 302 507.947619 $25397.3900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 141 150 235.533336 $11776.6800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 2.066667 $51.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 27 27 49.580953 $2479.0500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 254 267 397.928568 $19896.4200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 3.300000 $82.5000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 296 312 1789.747599 $89487.4400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 2 14.000000 $700.0000 $50.0000
INTR -T1013 INTERPRETER 12 17 49.565079 $2478.2600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 309 531 2107.919032 $21079.2100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 70 74 447.203030 $31948.1900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 6.571429 $375.8800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 64 68 378.646424 $27050.5200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 4 4 21.049314 $1203.1800 $57.1600
SENS -V5264 EARMOLD 1 1 0.622222 $11.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 63 68 399.633981 $28549.8500 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 24.000000 $333.1200 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 2 2 1.000000 $37.0000 $37.0000
TRAV -TRAVS Travel by mile 297 633 133288.089313 $59313.2000 $0.4500
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Subtotal (Total Children Is Unduplicated) 385 2648 139880.111083 $559597.5200 $4.0000
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Total 3104 140428.744085 $591923.8100 $4.2200
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Number of Children (Unduplicated) With at Least One Authorization 474