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: 10-01-22 and 12-31-22 Date of Report: 01-23-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2089 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 2.433333 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 2.433333 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 36 38 20.749390 $1006.3400 $48.5000
EXIT -EXIT EXIT ASSESSMENT 27 27 30.002740 $1500.1400 $50.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 11 11 17.510958 $1313.3300 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 10 11 21.000000 $1575.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 6 6 12.000000 $900.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 36 36 63.016437 $3497.4200 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 15 15 29.500000 $1637.2500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 10 10 19.500000 $1462.5000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 3 3 6.000000 $450.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.533333 $26.6700 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 3 3 0.683029 $35.1100 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 1.422222 $73.1200 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.071233 $3.6600 $51.3900
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.4100 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.071233 $3.6600 $51.3900
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.150685 $7.7500 $51.4200
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.011111 $0.5700 $51.3600
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Subtotal (Total Children Is Unduplicated) 126 171 229.222371 $13915.9100 $60.7100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 8.248620 $41243.0000 $4999.9900
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.833333 $41.6700 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 29 30 23.059232 $1152.9700 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 3 3 3.505556 $175.2800 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 219 249 364.376187 $18218.8000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 98 100 164.866664 $8243.3300 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 2 2 3.300000 $165.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.266667 $31.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 25 28 37.342855 $1867.1400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 193 204 290.542854 $14527.1300 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 3 3 5.833333 $291.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 3.333333 $83.3300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 5 5 28.719048 $1435.9500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 52 52 341.428576 $17071.4100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 1.571429 $78.5700 $50.0000
INTR -T1013 INTERPRETER 20 31 69.184051 $3459.2000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 279 534 1882.281685 $18822.8000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 3 3 20.428572 $1470.0300 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 1 1 1.428571 $102.8000 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 3 16.000000 $1151.3600 $71.9600
TRAV -TRAVS Travel by mile 320 661 105174.177499 $46802.5100 $0.4500
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Subtotal (Total Children Is Unduplicated) 361 1917 108441.728065 $176435.5900 $1.6300
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Total 2089 108673.383769 $190351.5000 $1.7500
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Number of Children (Unduplicated) With at Least One Authorization 393