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: 10-01-21 and 12-31-21 Date of Report: 02-04-22 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2187 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 20 20 22.516667 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 20 20 22.516667 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 1 1 2.000000 $100.0000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 10 10 16.233334 $1217.5100 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 7 7 6.211111 $465.8300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 3.000000 $225.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 7 7 14.000000 $1050.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 9 9 6.189497 $464.2100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 48 50 94.171365 $5226.5100 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 6 6 8.153424 $452.5100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 43 44 87.000000 $6525.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 79 80 120.661843 $9049.6100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 37 37 73.966667 $5547.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 4 4 7.000000 $525.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 20 21 38.966667 $2922.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 80 80 127.848143 $9588.5900 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 72 73 140.642857 $7805.6800 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 92 92 146.365299 $8123.2500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 2.002740 $150.2000 $75.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 0.716667 $35.8400 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 3 3 3.000000 $153.1500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 5 5 1.211111 $61.8300 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 38 38 29.113927 $1486.2600 $51.0500
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 0.500000 $25.5300 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 7 7 1.877778 $95.8600 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 27 27 18.493607 $944.1000 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 3 3 2.388889 $121.9500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.194444 $9.9200 $51.0400
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 44 45 19.279148 $984.2000 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 7 7 2.263166 $115.5300 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 3 3 1.483334 $75.7300 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 2.122222 $94.5400 $44.5500
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Subtotal (Total Children Is Unduplicated) 392 669 977.057240 $63643.3300 $65.1400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 5 3.142466 $15712.0000 $4999.8900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 41 46 43.427777 $2171.3900 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 15 17 13.000000 $650.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 3 3.000000 $75.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 258 273 345.762696 $17288.1100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 47 47 80.391271 $4019.5700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 121 129 171.368651 $8568.4300 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 30 30 63.588096 $3179.4200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 1.377777 $34.4400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 89 91 95.380556 $4769.0300 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 22 23 28.445236 $1422.2600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 1.800000 $45.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 192 205 230.997990 $11549.9100 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 60 63 87.171426 $4358.5600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 0.300000 $7.5000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 262 280 1573.683336 $78684.1800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 40 40 237.850000 $11892.5000 $50.0000
INTR -T1013 INTERPRETER 2 2 4.000000 $200.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1 1 3.000000 $30.0000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 60 62 345.814285 $24704.9800 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 1.142857 $81.6500 $71.4400
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 4.571429 $326.5800 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 4 4 20.285715 $1449.2100 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 56 59 325.176191 $23230.5700 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 4.000000 $285.7600 $71.4400
PHY -97110HM PT SESSION BY PT ASST 4 4 12.461904 $712.3200 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 2 2 6.428571 $459.2600 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 3 3 8.857143 $632.7600 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 83 88 424.111911 $30298.5300 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 5 5 22.290476 $1592.4300 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 6 6 30.176191 $2155.7800 $71.4400
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Subtotal (Total Children Is Unduplicated) 402 1498 4193.003951 $250587.1100 $59.7600
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Total 2187 5192.577858 $314230.4400 $60.5200
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Number of Children (Unduplicated) With at Least One Authorization 648