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: 10-01-22 and 12-31-22 Date of Report: 01-23-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 1976 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 42 42 48.699996 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 42 42 48.699996 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 1 1 2.000000 $100.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 8 8 12.320624 $924.0500 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 4 5 10.000000 $750.0000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 14 14 22.010958 $1650.8300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 1.500000 $112.5000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 7 7 9.005479 $675.4100 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 3 3 5.000000 $375.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 15 15 23.738552 $1317.4900 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 13 15 24.505479 $1360.0600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 35 36 70.500000 $5287.5000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 82 83 137.105174 $10282.8900 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 9 9 14.500000 $1087.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 31 31 56.010958 $4200.8300 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 24 24 45.500000 $3412.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 83 84 128.563010 $9642.2300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 93 93 178.532420 $9908.5500 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 104 105 159.128763 $8831.6500 $55.5000
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 1.000000 $50.0000 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.4100 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 3 3 2.194521 $112.8200 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 2 2 0.266667 $13.7100 $51.4200
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 0.083333 $4.2800 $51.3900
OCTH -97167 OT EVAL HIGH COMPLEXITY 19 19 8.239194 $423.5700 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 3 3 1.478386 $76.0000 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 3 3 3.000000 $154.2300 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 2 2 11.693651 $601.1700 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.111111 $5.7100 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 0.077778 $4.0000 $51.4200
PSTH -97163 PT EVAL HIGH COMPLEXITY 11 11 7.772221 $399.5600 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 3 3 1.098707 $56.4900 $51.4100
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 1 1 0.022222 $1.1400 $51.3600
SPCH -92521 EVAL OF SPEECH FLUENCY 13 13 9.911188 $509.5300 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 0.072222 $3.7100 $51.3900
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 2.000000 $102.8200 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 27 28 11.706164 $601.8100 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.061111 $3.1400 $51.4000
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.4100 $51.4100
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 1.000000 $51.4100 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 5 5 3.096195 $138.9000 $44.8600
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.8600 $44.8600
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 0.571429 $30.2400 $52.9300
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Subtotal (Total Children Is Unduplicated) 363 649 984.377517 $64563.7500 $65.5900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 3.131507 $15657.5000 $4999.9900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 33 40 26.949999 $1347.5000 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 18 21 15.527777 $776.3900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 7 7 7.500000 $187.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 237 250 263.859918 $13192.9800 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 74 75 96.046826 $4802.3500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.066667 $26.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 88 91 105.266672 $5263.3600 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 17 17 17.986508 $899.3300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 75 80 71.882541 $3594.1300 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 28 30 27.279364 $1363.9600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 2.466667 $61.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 170 173 199.026185 $9951.2900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 55 56 74.307143 $3715.3700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.633333 $40.8300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 10 11 65.428572 $3271.4300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 251 268 1397.065881 $69853.2700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 40 43 216.259528 $10812.9600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2 2 9.428571 $94.2900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 24 25 85.857144 $6178.2600 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 3.857143 $277.5600 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 1 2 11.000000 $791.5600 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 7.285714 $524.2800 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 29 29 158.890475 $11433.7500 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 1 1 0.071429 $5.1400 $71.9300
PHY -97110TL PT SESSION BY LICENSED PT 1 1 2.857143 $205.6000 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 2 2 9.428572 $678.4700 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 44 46 205.357145 $14777.4800 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 3 9.000001 $647.6300 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 2 2 7.357143 $529.4200 $71.9600
TRAV -TRAVS Travel by mile 1 1 45.000000 $20.0300 $0.4500
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Subtotal (Total Children Is Unduplicated) 354 1285 3148.075568 $180981.8900 $57.4900
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Total 1976 4181.153081 $245545.6400 $58.7300
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Number of Children (Unduplicated) With at Least One Authorization 641