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: 01-01-23 and 03-31-23 Date of Report: 04-20-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 4733 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 71 73 71.562698 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 71 73 71.562698 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 33 37 42.530659 $2062.7300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 3 3 3.282192 $184.1300 $56.1000
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 1.000000 $86.9400 $86.9400
EXIT -EXIT EXIT ASSESSMENT 47 49 55.793934 $2789.7000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 3 6.000000 $450.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 12 12 24.000000 $1800.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 10 10 18.500000 $1387.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 14 14 28.000000 $2100.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 40 40 77.500000 $4301.2500 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 13 13 26.600000 $1476.3000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 29 36 71.000000 $5325.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 11 13 26.000000 $1950.0000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 3 3 3.000000 $154.2300 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.4100 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.057534 $2.9600 $51.3800
SPCH -92521 EVAL OF SPEECH FLUENCY 3 3 3.000000 $154.2300 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.4100 $51.4100
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Subtotal (Total Children Is Unduplicated) 165 249 405.264319 $25501.2000 $62.9200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 9 10 7.801370 $39007.0000 $5000.0200
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $231.6200 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 414 475 492.043764 $24602.1900 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 21 26 1.584936 $79.2200 $49.9800
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 67 71 131.156557 $3278.9100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 177 191 345.179370 $17258.9900 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 23 23 34.516667 $1725.8400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 8 9 8.866668 $221.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 60 65 118.521430 $5926.0800 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 4 5 5.483333 $274.1700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 2.600000 $65.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 73 79 134.738890 $6736.9500 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 12 12 17.766666 $888.3300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 8.033334 $200.8400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 127 137 229.538897 $11476.9900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 15 16 20.050000 $1002.5000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 8 8 16.666667 $416.6700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 42 44 264.819047 $13240.9700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 58 62 438.185716 $21909.2800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 5 5 29.285715 $1464.2900 $50.0000
INTR -T1013 INTERPRETER 190 236 475.364286 $23768.2200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1077 1430 8750.892871 $87508.9600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 5 5 20.666667 $1487.1800 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 3 8.428571 $606.5200 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 10 11 46.342857 $3334.8400 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 1 1 0.714286 $51.4000 $71.9600
PHY -97110HM PT SESSION BY PT ASST 1 1 1.714286 $98.6800 $57.5600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 16 16 104.776190 $7539.7000 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 0.428571 $30.8400 $71.9600
TRAV -TRAVS Travel by mile 1103 1462 8877.178584 $3950.3500 $0.4500
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Subtotal (Total Children Is Unduplicated) 1314 4411 20594.346196 $278384.1500 $13.5200
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Total 4733 21071.173213 $303885.3500 $14.4200
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Number of Children (Unduplicated) With at Least One Authorization 1434