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 1649 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
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Subtotal (Total Children Is Unduplicated) 3 3 13.030158 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 29 30 18.993986 $921.2100 $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 -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 2 2 4.500000 $337.5000 $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 24 24 50.504110 $2802.9800 $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
OCTH -97166 OT EVAL MODERATE COMPLEXITY 4 4 0.208220 $10.6200 $51.0200
OCTH -97167 OT EVAL HIGH COMPLEXITY 2 2 0.198249 $10.1200 $51.0400
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 2 1.066667 $54.4600 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.095890 $4.9000 $51.0600
PSTH -97163 PT EVAL HIGH COMPLEXITY 3 3 0.453805 $23.1700 $51.0500
SCREEN-T1023 SCREENING 1 1 1.000000 $50.0000 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 9 10 2.780670 $141.9500 $51.0500
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Subtotal (Total Children Is Unduplicated) 112 155 181.925493 $10523.9300 $57.8500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 7 4.542465 $22712.5000 $5000.0400
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 54 54 290.580954 $14529.0500 $50.0000
INTR -T1013 INTERPRETER 13 16 35.773015 $1788.6500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 204 368 1505.995242 $15059.9500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 8 9 54.857144 $3919.0000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 7 7 58.857143 $4204.7500 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 9 9 44.285714 $3163.7800 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 12.285714 $877.6900 $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 1 1 6.857143 $95.1800 $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
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Subtotal (Total Children Is Unduplicated) 254 1491 89538.783636 $150832.5000 $1.6800
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Total 1649 89733.739287 $161356.4300 $1.8000
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Number of Children (Unduplicated) With at Least One Authorization 296