Summary Report for FSPSAs Initiated During the Report Period Center: 02
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: 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 1679 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 1 1 0.084932 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 0.084932 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 19 21 17.032191 $826.0600 $48.5000
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 0.494444 $24.7200 $50.0000
EXIT -EXIT EXIT ASSESSMENT 38 38 41.473972 $2073.7100 $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
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 0.183333 $9.3600 $51.0400
OCTH -97165 OT EVAL LOW COMPLEXITY 3 3 3.000000 $153.1500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 2 2 0.650000 $33.1800 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.316667 $16.1700 $51.0600
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 0.211111 $10.7800 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 4 4 4.000000 $204.2000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.483333 $24.6700 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 9.142857 $407.3200 $44.5500
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.241096 $10.7400 $44.5500
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Subtotal (Total Children Is Unduplicated) 95 133 193.229004 $11319.6000 $58.5800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 5 1.649315 $8246.5000 $4999.9500
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 2.166667 $108.3400 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 52 52 47.482540 $2374.1300 $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 212 239 498.977783 $24948.9100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 4.714286 $235.7200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.800000 $45.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 112 114 227.947622 $11397.3900 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 5 5 11.733334 $586.6700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.733333 $18.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 22 22 60.060316 $3003.0100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 2.533333 $63.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 179 190 341.510321 $17075.5300 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 6 6 7.866667 $393.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.566667 $14.1700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 43 43 274.703172 $13735.1600 $50.0000
INTR -T1013 INTERPRETER 15 23 73.912393 $3695.6200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 213 374 1871.433318 $18714.3500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 4 30.857142 $2204.4300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 5.428571 $310.5200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1 1 6.142857 $438.8500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 5.428571 $310.3000 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 2.285714 $130.6500 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 7 7 41.857142 $2990.2800 $71.4400
TRAV -TRAVS Travel by mile 231 438 96762.664792 $43059.3900 $0.4500
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Subtotal (Total Children Is Unduplicated) 284 1545 100298.711412 $154743.7800 $1.5400
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Total 1679 100492.025348 $166063.3700 $1.6500
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Number of Children (Unduplicated) With at Least One Authorization 311