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 1205 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 41 41 48.277774 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 41 41 48.277774 $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 2 2 2.115068 $158.6300 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 4 4 4.010958 $300.8300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 1.500000 $112.5000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 4 4 4.005479 $300.4100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 5 5 9.571429 $531.2100 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 6 8 13.505479 $749.5600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 16 16 30.500000 $2287.5000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 28 29 48.016437 $3601.2400 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 3 3 5.000000 $375.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 8 8 14.005479 $1050.4100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 9 9 16.500000 $1237.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 26 27 42.519177 $3188.9400 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 32 32 59.965753 $3328.1000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 37 38 60.030135 $3331.6800 $55.5000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.000000 $50.0000 $50.0000
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.093151 $4.7900 $51.4400
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.4100 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 0.072222 $3.7100 $51.3900
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 0.327778 $16.8500 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.061111 $3.1400 $51.4000
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.8600 $44.8600
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Subtotal (Total Children Is Unduplicated) 104 198 322.799656 $21278.2700 $65.9200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 1.131507 $5657.5000 $4999.9700
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 5 5 43.285715 $2164.2900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 84 89 448.916670 $22445.8100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 17 17 79.669051 $3983.4400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2 2 9.428571 $94.2900 $10.0000
PHY -97110 PT SESSION BY LICENSED PT 1 1 4.571429 $328.9600 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 4 11.571429 $832.6800 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 2 8.428572 $606.5100 $71.9600
TRAV -TRAVS Travel by mile 1 1 45.000000 $20.0300 $0.4500
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Subtotal (Total Children Is Unduplicated) 321 966 1562.802544 $81356.7800 $52.0600
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Total 1205 1933.879974 $102635.0500 $53.0700
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Number of Children (Unduplicated) With at Least One Authorization 438