Summary Report for FSPSAs Initiated During the Report Period Center: 02
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: 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 2223 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 13.030158 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 3 3 13.030158 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 39 42 29.333712 $1422.6800 $48.5000
EVAL -96111 DEVELOPMENTAL EVALUATION 2 3 0.366666 $18.3300 $49.9900
EXIT -EXIT EXIT ASSESSMENT 49 50 54.253120 $2712.6500 $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 25 25 50.000000 $3750.0000 $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 25 25 44.023286 $3301.7500 $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 76 77 153.027396 $8493.0200 $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 5 5 1.734171 $88.5300 $51.0500
OCTF -97168GT OT RE-EVAL EST PLAN CARE 1 1 0.150685 $7.6900 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 9 9 8.653513 $441.7600 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 18 19 9.776711 $499.1000 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 7 7 3.241858 $165.5000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 0.249315 $12.7300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 21 21 10.150990 $518.2100 $51.0500
SCREEN-T1023 SCREENING 1 1 1.000000 $50.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 5 5 4.150685 $211.8900 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 36 37 14.981204 $764.7900 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.112329 $56.7800 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 4 4.081801 $181.8400 $44.5500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 204 391 504.291552 $30635.0200 $60.7500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 48 51 36.677929 $183389.5000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 76 86 95.844941 $4792.2500 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 5 5 3.849999 $192.5000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 16 16 13.520835 $338.0300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 183 199 339.676189 $16983.8300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.071429 $26.7900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 109 111 181.757143 $9087.8600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 5.666667 $141.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 20 20 26.819047 $1340.9500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 165 170 249.623809 $12481.1900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 5.999999 $150.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 188 192 1134.928574 $56746.4200 $50.0000
INTR -T1013 INTERPRETER 13 16 35.773015 $1788.6500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 204 369 1511.709528 $15117.0900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 51 54 340.867711 $24351.5900 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 3 3 17.285714 $1234.8900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 3 3 19.571428 $1119.4900 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 44 45 325.031638 $23220.2600 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 5 5 35.571429 $2541.2100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 3.357143 $191.8900 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 60 61 325.303426 $23239.6500 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 21.714285 $1551.2700 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 6.571429 $375.8800 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 8 8 55.428571 $769.3500 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 2 2 1.000000 $37.0000 $37.0000
TRAV -TRAVS Travel by mile 189 401 86593.347615 $38534.0400 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 267 1829 91387.969493 $419743.2200 $4.5900
-------------------------------------------------------------------------------------------------------------------------------------
Total 2223 91905.291203 $450378.2400 $4.9000
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 326