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 1291 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 16 16 13.633337 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 16 16 13.633337 $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 4 6 11.000000 $550.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 8 8 12.123288 $909.2400 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 5 5 9.538812 $715.4100 $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 7 7 9.837378 $737.8100 $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 5 5 2.454795 $184.1000 $75.0000
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 32 32 49.513700 $2748.0000 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 19 19 9.613698 $533.5500 $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 2 2 3.000000 $225.0000 $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 -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 0.087671 $6.5800 $75.0200
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 3.000000 $225.0000 $75.0000
OCTH -97167 OT EVAL HIGH COMPLEXITY 3 3 0.235616 $12.0300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 2 1.472222 $75.1600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.227397 $11.6100 $51.0500
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Subtotal (Total Children Is Unduplicated) 124 180 159.393770 $10181.0000 $63.8700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.134247 $10671.0000 $4999.8900
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 92 107.869047 $5393.4600 $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 104 108 631.109524 $31555.4600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 81 92 632.999997 $31650.0300 $50.0000
INTR -T1013 INTERPRETER 2 2 13.000000 $650.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 8 9 41.785715 $2985.1600 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 2 4 12.285716 $877.6800 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 10.142857 $724.6100 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 2 2 6.928572 $494.9700 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 5 5 14.000001 $1000.1500 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 3 10.000001 $714.3900 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 10.714286 $765.4300 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 2.285714 $31.7300 $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) 371 1095 2610.668872 $140942.2400 $53.9900
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Total 1291 2783.695979 $151123.2300 $54.2900
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Number of Children (Unduplicated) With at Least One Authorization 434