Summary Report for FSPSAs Initiated During the Report Period Center: 05
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 2333 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 17 17 15.133337 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 17 17 15.133337 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 2 2.000000 $97.0000 $48.5000
EXIT -EXIT EXIT ASSESSMENT 7 9 17.000000 $850.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 12 12 18.123288 $1359.2400 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 12 12 20.544291 $1540.8200 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 6 6 4.019407 $301.4600 $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 10.837378 $812.8100 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 6 6 4.024810 $301.8600 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 11 11 3.468495 $260.1200 $74.9900
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 2 2 1.010959 $75.8300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 59 60 97.726028 $5423.7900 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 24 24 19.613698 $1088.5500 $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 4 4 5.002740 $375.2000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 40 40 20.615073 $1546.1200 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 35 35 38.065755 $2112.6500 $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 8 8 6.120548 $459.0500 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 3.000000 $225.0000 $75.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 27 27 13.193379 $673.5200 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 4 4 0.706925 $36.0800 $51.0400
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 0.194444 $9.9200 $51.0400
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 2 2 1.138889 $58.1400 $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 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 5 5 2.933333 $149.7400 $51.0500
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 0.344444 $17.5800 $51.0400
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 37 37 29.280735 $1494.7700 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 3 3 1.279376 $65.3100 $51.0500
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 2 3 0.475037 $24.2500 $51.0500
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 45 46 36.083106 $1842.0500 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 1.522222 $77.7100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 2 2 2.000000 $102.1000 $51.0500
SPCH -92524TLGT BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.188889 $9.6400 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 11 11 9.101370 $405.4700 $44.5500
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 2.000000 $89.1000 $44.5500
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Subtotal (Total Children Is Unduplicated) 295 492 460.347649 $28028.6800 $60.8900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 9 9 10.095108 $50475.5000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 12 12 8.363993 $418.2000 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 25 28 22.476582 $1123.8300 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 248 256 470.069845 $23503.5100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 43 47 47.423810 $2371.1900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 89 93 110.797618 $5539.8900 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 25 26 23.194443 $1159.7200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 11.714286 $292.8600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 104 107 101.387298 $5069.3500 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 22 23 26.661110 $1333.0500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 2.350000 $58.7500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 192 198 203.077785 $10153.9300 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 33 33 45.547618 $2277.3800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 293 305 1794.857145 $89742.8100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 169 189 1337.076186 $66853.8600 $50.0000
INTR -T1013 INTERPRETER 2 2 13.000000 $650.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 65 70 335.620636 $23976.7100 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 27 32 194.923015 $13925.3000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 11.714286 $670.0500 $57.2000
OCCT -97530TLGT OT SESSION BY LICENSED OT 19 20 136.285712 $9736.2400 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 58 60 356.704769 $25482.9600 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 21 22 123.383334 $8814.5100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 3 24.714286 $1412.6700 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 11.571429 $661.4200 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 2 2 7.233333 $516.7500 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 11 13 90.142857 $6439.8100 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 121 124 717.880160 $51285.3300 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 61 62 413.720632 $29556.2000 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 5.428572 $310.5200 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 2 2 7.357143 $525.6000 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 25 26 165.538097 $11826.0400 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 12 12 59.785714 $829.8300 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 36 39 153.146425 $5666.4300 $37.0000
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Subtotal (Total Children Is Unduplicated) 462 1824 7043.243227 $452660.1600 $64.2700
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Total 2333 7518.724213 $480688.8400 $63.9300
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Number of Children (Unduplicated) With at Least One Authorization 557