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 1489 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 14 15 22.200000 $1110.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 5 5 6.123288 $459.2400 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 4 4 5.005479 $375.4100 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 3 3 1.008296 $75.6200 $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 5 5 5.837378 $437.8100 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 2 2 0.009589 $0.7200 $75.0900
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 3 3 0.093151 $6.9800 $74.9600
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 21 21 32.015070 $1776.8300 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 19 19 9.113698 $505.8000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 2 2 3.500000 $262.5000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 25 28 18.586301 $1393.9800 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 14 14 7.542466 $565.6900 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 11 11 7.532877 $418.0800 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 20 22 5.093149 $282.6800 $55.5000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 3.000000 $225.0000 $75.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.388889 $19.8500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 5 5 0.422832 $21.5900 $51.0600
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 5 5 0.331508 $16.9200 $51.0300
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Subtotal (Total Children Is Unduplicated) 121 171 131.820486 $8255.9500 $62.6300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 6 5.283333 $26416.5000 $4999.9700
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 323 348 331.234127 $16561.7100 $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 126 129 118.257536 $5912.8600 $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 270 288 273.444448 $13672.2400 $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 5 6 25.857143 $646.4300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 117 127 591.661903 $29583.0900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 64 70 403.966664 $20198.3500 $50.0000
INTR -T1013 INTERPRETER 5 5 29.285714 $1464.2900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1 1 1.466667 $14.6700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 11 11 43.642857 $3117.8300 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 3 3 9.000001 $642.9500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 4 4 24.361904 $1740.4100 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 9.714286 $693.9900 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 12 13 75.142857 $5368.1900 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 6.857142 $489.8800 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 2 2 9.714286 $693.9800 $71.4400
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 32 33 91.579763 $3388.4400 $37.0000
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Subtotal (Total Children Is Unduplicated) 439 1297 2439.129055 $149910.7600 $61.4600
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Total 1489 2602.798750 $158166.7100 $60.7700
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Number of Children (Unduplicated) With at Least One Authorization 513