Summary Report for FSPSAs Initiated During the Report Period Center: 05
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 1094 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 12 12 16.912698 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 12 12 16.912698 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 2 2 2.011111 $150.8300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 3 3 2.016590 $151.2500 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 4 4 8.000000 $444.0000 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 3 3 4.005479 $222.3100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 19 19 38.000000 $2850.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 30 30 52.060275 $3904.5200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 12 12 23.500000 $1762.5000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 6 6 11.500000 $862.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 26 26 42.358904 $3176.9000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 28 28 54.000000 $2997.0000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 32 32 48.436530 $2688.2100 $55.5000
OCTH -97167 OT EVAL HIGH COMPLEXITY 2 2 0.152131 $7.7700 $51.0700
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.288889 $65.8000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.5500 $44.5500
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Subtotal (Total Children Is Unduplicated) 92 177 302.329909 $20378.1300 $67.4000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 2.117808 $10589.0000 $4999.9800
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 47 53 51.538890 $2576.9500 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 16 19 12.527777 $626.3900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 4 4 4.733333 $118.3300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 247 256 324.210315 $16210.4900 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 27 27 31.428572 $1571.4200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 129 132 168.556353 $8427.8300 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 9 9 10.347619 $517.3800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 2.333333 $58.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 72 73 89.503972 $4475.2200 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 10 10 13.055556 $652.7800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 195 199 236.986116 $11849.3300 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 36 37 52.941269 $2647.0600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.788889 $19.7200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 69 72 465.930948 $23296.5900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 7 7 43.885713 $2194.2900 $50.0000
INTR -T1013 INTERPRETER 1 1 2.000000 $100.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 344 905 1512.886463 $85931.0900 $56.8000
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Total 1094 1832.129070 $106309.2200 $58.0200
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Number of Children (Unduplicated) With at Least One Authorization 400