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 1839 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 22 24 19.767352 $958.7200 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $14.5800 $14.5800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.533333 $36.0300 $23.5000
EXIT -EXIT EXIT ASSESSMENT 50 50 62.552381 $3127.6200 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 3 6.000000 $333.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 10 10 20.000000 $1500.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 2 2 2.500000 $187.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 1 1 2.500000 $187.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 25 26 53.000000 $2941.5000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 13 14 29.000000 $2175.0000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 2 3 1.383333 $70.6200 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 2.000000 $102.1000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 2.900000 $148.0500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 3.255556 $145.0400 $44.5500
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 2 0.432877 $19.2900 $44.5500
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Subtotal (Total Children Is Unduplicated) 111 151 214.824832 $12351.7900 $57.5000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 1.175342 $5876.5000 $4999.8200
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 227 270 420.694046 $21034.6900 $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 191 215 332.149998 $16607.4900 $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 53 56 329.376190 $16468.8000 $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 4 4 23.142857 $1653.3300 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 13.142857 $938.9300 $71.4400
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 10.857143 $775.6300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 2 2 8.000000 $571.5200 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 10.857143 $775.6300 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 6 8 60.428572 $4317.0300 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 11.714286 $162.5900 $13.8800
TRAV -TRAVS Travel by mile 258 464 95965.129946 $42704.4800 $0.4500
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Subtotal (Total Children Is Unduplicated) 322 1688 99346.600112 $148604.9900 $1.5000
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Total 1839 99561.424944 $160956.7800 $1.6200
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Number of Children (Unduplicated) With at Least One Authorization 351