Summary Report for FSPSAs Ending During the Report Period Center: 05
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 2762 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 21 21 31.849209 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 21 21 31.849209 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 23 24 38.200000 $1910.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 7 7 9.123288 $684.2400 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 15 15 22.010958 $1650.8300 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 6 6 4.019407 $301.4600 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 1 1 0.005556 $0.4200 $75.5900
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 8 8 11.837378 $887.8100 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 8 8 7.024810 $526.8600 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 9 9 2.106851 $158.0000 $74.9900
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 1 1 0.010959 $0.8300 $75.2800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 45 47 70.426029 $3908.6400 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 22 22 15.113698 $838.8000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 15 15 25.002740 $1875.2000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 38 41 30.106850 $2258.0200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 6 6 9.002740 $675.2000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 3 3 4.002740 $300.2000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 39 39 18.615073 $1396.1200 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 36 36 38.095892 $2114.3200 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 30 32 17.609588 $977.3400 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 9 9 6.490411 $486.7900 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 3.000000 $225.0000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 17 17 8.339879 $425.7600 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 51 51 27.915070 $1425.0700 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 0.272222 $13.9000 $51.0500
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 2 2 0.538889 $27.5100 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.0500 $51.0500
PSTF -97164TL PT RE-EVAL EST PLAN CARE 1 1 0.005556 $0.2900 $51.4600
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 5 5 3.438889 $175.5600 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 39 40 30.275866 $1545.5900 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 2 2 0.279376 $14.2600 $51.0400
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 1 1 0.083333 $4.2500 $51.0300
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.022222 $1.1300 $51.0000
SPCH -92522 EVAL OF SPCH SOUND PROD 7 7 5.294444 $270.2800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 102 103 65.211332 $3329.0300 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 4 4 3.188889 $162.7900 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 13 13 11.508067 $512.6900 $44.5500
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Subtotal (Total Children Is Unduplicated) 389 584 494.179002 $29438.3500 $59.5700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 21 21 18.048173 $90240.5000 $4999.9800
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 24 24 85.392564 $4269.6300 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 23 25 17.043249 $852.1700 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 324 349 331.734127 $16586.7100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 25 28 28.172221 $1408.6100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.466667 $36.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 126 130 121.186107 $6059.2900 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 8 8 5.977777 $298.8900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 3.100000 $77.5000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 131 139 228.328171 $11416.3800 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 7 7 7.044443 $352.2200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.016667 $0.4200 $25.0500
CONSF -CONSF CONSULT, SLP, FACE TO FACE 271 290 276.377782 $13818.9100 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 12 12 11.583332 $579.1600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.533333 $13.3300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 11 13 56.999999 $1425.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 329 356 1929.299990 $96465.0500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 130 145 875.966665 $43798.3600 $50.0000
INTR -T1013 INTERPRETER 6 6 34.285714 $1714.2900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1 1 1.466667 $14.6700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 95 98 472.819049 $33778.1900 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 34 36 178.646824 $12762.5300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 11.342857 $648.8100 $57.2000
OCCT -97530TLGT OT SESSION BY LICENSED OT 6 6 30.071428 $2148.3000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 89 92 476.582532 $34047.1100 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 20 20 97.785713 $6985.8200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 11 11 72.357142 $4135.9400 $57.1600
PHY -97110TLGT PT SESSION BY LICENSED PT 4 4 19.571429 $1398.1900 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 186 200 1047.219837 $74813.4200 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 59 61 346.821426 $24776.9500 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 16 16 81.785714 $5842.7600 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 18 18 124.142855 $1723.1000 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 33 34 98.865477 $3658.0100 $37.0000
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Subtotal (Total Children Is Unduplicated) 509 2157 7092.035931 $496146.8600 $69.9600
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Total 2762 7618.064142 $525585.2100 $68.9900
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Number of Children (Unduplicated) With at Least One Authorization 659