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 2367 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 39 42 21.461112 $1040.8600 $48.5000
EXIT -EXIT EXIT ASSESSMENT 68 68 69.639967 $3482.0000 $50.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.500000 $138.7500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 4 4 8.000000 $600.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 3 3 5.500000 $412.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 8 8 14.504110 $1087.8100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 26 26 53.504110 $2969.4800 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 8 8 18.500000 $1387.5000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 0.038889 $1.9900 $51.0600
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.400000 $20.4200 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 6 6 1.016439 $51.8900 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 6 7 5.661111 $289.0000 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.244444 $12.4800 $51.0400
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 3 0.405480 $20.7000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 2 1.494444 $76.2900 $51.0500
SCREEN-T1023 SCREENING 1 1 1.000000 $50.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.400000 $20.4200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 9 9 2.313167 $118.0900 $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) 143 195 210.706561 $12008.4700 $56.9900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 9 11 4.665755 $23329.5000 $5000.1600
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 75 78 476.914279 $23845.7300 $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 9 10 62.857141 $4490.5200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 9 9 61.595237 $4400.3700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 17.857142 $1020.7200 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 11 11 68.109523 $4865.7500 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 11.000000 $152.6800 $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) 358 2169 137455.195815 $209841.9100 $1.5300
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Total 2367 137679.188090 $221850.3700 $1.6100
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Number of Children (Unduplicated) With at Least One Authorization 401