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: 10-01-20 and 12-31-20 Date of Report: 01-23-21 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2423 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 18 18 20.638095 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 18 18 20.638095 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 1 1 2.000000 $100.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 4 4 8.000000 $600.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 18 18 44.434127 $3332.5700 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 7 7 11.005479 $825.4100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 3 3 5.000000 $375.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 3 3 2.005479 $150.4100 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 8 8 12.005479 $900.4100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 91 92 178.083529 $9883.6300 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 14 14 13.585845 $754.0100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 46 46 81.090411 $6081.7800 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 74 74 118.074123 $8855.5700 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 27 27 50.000000 $3750.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 20 20 26.008219 $1950.6200 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 98 99 161.057534 $12079.3100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 78 80 133.158903 $7390.3200 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 48 48 79.021917 $4385.7200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 0.005479 $0.4100 $75.2900
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 3 3 6.000000 $450.0000 $75.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 3 3 0.483333 $24.6700 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 27 27 19.138335 $977.0100 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 4 4 1.742541 $88.9500 $51.0500
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 0.316667 $16.1700 $51.0600
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.0500 $51.0500
PSTF -97164GT 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 7 7 2.872223 $146.6300 $51.0500
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 0.161111 $8.2200 $51.0500
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 2 2 0.288889 $14.7500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 40 42 26.591468 $1357.4900 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 2 2 0.355555 $18.1500 $51.0400
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 2 2 0.750000 $38.2900 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 68 68 33.942228 $1732.7500 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 5 5 3.166666 $161.6600 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 2.083333 $106.3500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 2 2.000000 $102.1000 $51.0500
SPCH -92524TLGT BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.327778 $16.7300 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 12 12 9.728006 $433.3800 $44.5500
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.5500 $44.5500
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Subtotal (Total Children Is Unduplicated) 433 742 1049.490213 $68107.5100 $64.9000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 12 12 18.331507 $91657.5000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 24 27 26.559557 $1327.9800 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 26 30 23.783333 $1189.1700 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 257 270 309.688092 $15484.3900 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 36 37 30.425399 $1521.2800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 86 91 112.446028 $5622.2800 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 16 16 18.647618 $932.3700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 3 5.661904 $141.5500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 110 113 102.309524 $5115.4800 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 29 29 27.435714 $1371.7900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 210 221 230.821815 $11541.0400 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 33 34 54.317460 $2715.8800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.566667 $39.1700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 280 295 1650.623811 $82531.1900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 96 99 500.572147 $25028.6100 $50.0000
INTR -T1013 INTERPRETER 1 1 5.714286 $285.7200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 56 58 385.802381 $27561.7000 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 11 11 50.700793 $3622.0700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 3 3 15.857143 $907.0300 $57.2000
OCCT -97530TLGT OT SESSION BY LICENSED OT 10 10 71.971430 $5141.6200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 62 65 306.716667 $21911.8300 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 11 11 43.859525 $3133.3100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 3 13.571429 $775.7400 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 3 3 11.466667 $819.1800 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 10 10 51.642858 $3689.3500 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 127 132 696.884125 $49785.4100 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 28 29 134.507144 $9609.1700 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 10.857143 $621.0300 $57.2000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 5.000000 $286.0000 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 3 3 27.285714 $1949.2900 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 16 16 62.971428 $4498.6800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 10 11 86.499999 $1200.6200 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 0.285714 $3.9700 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 14 15 26.395239 $976.6300 $37.0000
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Subtotal (Total Children Is Unduplicated) 396 1663 5121.180261 $382997.9800 $74.7900
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Total 2423 6191.308569 $451105.4900 $72.8600
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Number of Children (Unduplicated) With at Least One Authorization 636