Summary Report for FSPSAs Ending During the Report Period Center: 01
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: 10-01-22 and 12-31-22 Date of Report: 01-23-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 4584 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 86 88 174.520633 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.377778 $14.0500 $37.2000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 87 89 174.898411 $14.0500 $0.0800
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 23 24 17.684475 $857.7000 $48.5000
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 1.000000 $50.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 4 4 3.016667 $150.8400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 6 12.000000 $900.0000 $75.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 13 14 25.785714 $1933.9300 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 3 3 6.000000 $450.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 15 15 28.285714 $2121.4300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 35 35 70.000000 $3885.0000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 11 11 21.000000 $1165.5000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 35 42 82.000000 $6150.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 17 22 43.000000 $3225.0000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 6 6 6.000000 $308.4600 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 3.571429 $189.0300 $52.9300
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 118 193 331.343999 $22145.3400 $66.8300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.052055 $260.5000 $5004.3200
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 2.000000 $463.2400 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 366 414 444.096019 $22204.7900 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 25 33 6.109596 $305.4600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 46 47 43.265363 $1081.6300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 185 199 325.124599 $16256.2100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 16 18 26.788890 $1339.4500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 7 7 9.042857 $226.0700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 56 61 116.753968 $5837.7100 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 8 9 12.566666 $628.3300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 5.083334 $127.0900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 62 69 102.907687 $5145.3900 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 11 11 13.016666 $650.8300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 4.133333 $103.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 138 152 336.140469 $16806.9900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 14 15 17.455555 $872.7800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 12.133333 $303.3300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 40 41 270.533334 $13526.6700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 66 69 463.561905 $23178.1000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 10 12 54.161904 $2708.1000 $50.0000
INTR -T1013 INTERPRETER 150 175 383.750002 $19187.5100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1103 1450 8043.549580 $80435.4800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 4 27.523809 $1980.6200 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 5.266667 $378.9900 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 12 13 30.847620 $2219.7800 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 6 6 48.428572 $3484.9100 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 4.714286 $339.2400 $71.9600
TRAV -TRAVS Travel by mile 1132 1482 8156.180532 $3629.5000 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1290 4302 18966.188601 $223732.0100 $11.8000
-------------------------------------------------------------------------------------------------------------------------------------
Total 4584 19472.431011 $245891.4100 $12.6300
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1418