Summary Report for FSPSAs Ending During the Report Period Center: 02
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: 10-01-21 and 12-31-21 Date of Report: 02-04-22 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2679 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
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 32 35 26.517808 $1286.1100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 2.000000 $111.4200 $55.7100
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 2.000000 $29.1600 $14.5800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 2.571689 $60.4400 $23.5000
EXIT -EXIT EXIT ASSESSMENT 50 50 62.552381 $3127.6200 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 5 6 12.000000 $666.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 107 107 191.780034 $14383.5200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 29 29 59.214286 $4441.0700 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 5 5 11.000000 $825.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 128 135 248.494320 $13791.4500 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 1.500000 $83.2500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 39 43 87.000000 $6525.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 0.008219 $0.4200 $50.9300
OCTH -97165 OT EVAL LOW COMPLEXITY 5 5 4.327778 $220.9300 $51.0500
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 1 1 0.022222 $1.1300 $51.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 8 9 5.112633 $261.0000 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 31 32 21.292770 $1086.9900 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.008219 $0.4200 $50.9300
PSTH -97162 PT EVAL MODERATE COMPLEXITY 10 11 7.821309 $399.2800 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 15 15 9.517656 $485.8700 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 6 6 6.000000 $306.3000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 3 4 2.338888 $119.4000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 36 39 20.021842 $1022.1100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 2 2 0.538889 $27.5100 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 9 9 5.576104 $248.4200 $44.5500
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 3 1.432877 $63.8400 $44.5500
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Subtotal (Total Children Is Unduplicated) 305 562 801.649924 $50374.7000 $62.8400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 39 42 49.227092 $246134.5000 $4999.9800
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.000000 $68.8600 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $230.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 53 53 44.297107 $2214.8500 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 7 8 11.500000 $575.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 4 4 2.755556 $68.8900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 227 271 421.794046 $21089.6900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 118 125 189.861906 $9493.1000 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 21 21 32.009524 $1600.4800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 2.333333 $58.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 21 21 32.647621 $1632.3900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 4.733333 $118.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 192 216 334.249998 $16712.4900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 4 4 10.400000 $520.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 2.533333 $63.3300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 233 247 1508.590480 $75429.5100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 2.285714 $114.2900 $50.0000
INTR -T1013 INTERPRETER 15 22 50.340964 $2517.0500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 235 398 1774.233341 $17742.3300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 61 64 422.185715 $30160.9400 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 7 7 52.000000 $3714.8900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 20.142857 $1152.1700 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 10.857143 $775.6300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 40 41 300.471429 $21465.6800 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 4 4 17.723810 $1266.1900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 0.571429 $32.6600 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 82 88 610.504764 $43614.4800 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 12.620635 $901.6200 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 2 2 18.428572 $255.7900 $13.8800
TRAV -TRAVS Travel by mile 258 464 95965.129946 $42704.4800 $0.4500
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Subtotal (Total Children Is Unduplicated) 340 2117 101906.429648 $542427.9600 $5.3200
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Total 2679 102708.079572 $592802.6700 $5.7700
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Number of Children (Unduplicated) With at Least One Authorization 447