Summary Report for FSPSAs Initiated During the Report Period Center: 05
This report shows the total number of units/fees for FSPSAs initiated during the report period.
(i.e., start 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 starting 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 2324 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 28 28 31.368254 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 28 28 31.368254 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 12 12 21.106849 $1583.0100 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 0.500000 $37.5000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 13 13 22.500000 $1687.5000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 8 8 14.011111 $1050.8300 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 3 3 5.500000 $412.5000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 5 5 8.000000 $600.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 4 4 8.000000 $600.0000 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 18 18 30.500000 $1692.7500 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 14 14 21.659056 $1202.0700 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 24 24 48.000000 $3600.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 82 82 150.680821 $11301.0700 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 12 12 22.500000 $1687.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 58 58 111.505479 $8362.9100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 39 39 71.500000 $5362.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 65 66 126.405479 $9480.4100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 104 105 202.500000 $11238.7500 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 115 116 209.591779 $11632.3500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 0.161111 $8.2800 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 16 16 8.441705 $433.9900 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 0.144444 $7.4200 $51.3900
OCTH -97166 OT EVAL MODERATE COMPLEXITY 6 6 3.644445 $187.3600 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 20 20 8.524200 $438.2300 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 0.255556 $13.1400 $51.4200
PSTH -97161 PT EVAL LOW COMPLEXITY 13 18 15.827778 $813.7100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 5 6 2.927778 $150.5200 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 10 10 6.605556 $339.5900 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 2 2 1.158904 $59.5800 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.4100 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 15 17 5.097259 $262.0500 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 0.461110 $23.7000 $51.4000
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.4100 $51.4100
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Subtotal (Total Children Is Unduplicated) 348 693 1143.710420 $75327.6900 $65.8600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 15 18 16.263014 $81315.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 44 45 40.665080 $2033.2600 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 22 27 24.881745 $1244.0900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 11 11 10.500000 $262.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 265 274 268.821423 $13441.0500 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 74 78 96.141268 $4807.0600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.011111 $0.2800 $24.9800
CONOF -CONOF CONSULT, OT, FACE TO FACE 99 104 102.317461 $5115.8800 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 72 73 76.848414 $3842.4200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 90 103 74.934118 $3746.6700 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 45 57 37.288089 $1864.3700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 151 163 137.344435 $6867.1800 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 80 88 96.554761 $4827.7300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.272222 $31.8100 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 1.533333 $38.3300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 12 12 77.571428 $3878.5700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 286 309 1575.218242 $78760.9900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 44 47 253.506344 $12675.3200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2 3 3.000000 $30.0000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 45 48 245.161905 $17641.8500 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 2 3 14.961904 $1076.6600 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 2 2 19.428572 $1398.0800 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 34 43 160.854760 $11575.1300 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 6 7 23.071427 $1660.2300 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 3 3 14.785714 $1063.9800 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 3 3 10.066667 $724.4000 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 49 59 253.406343 $18235.1600 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 10 11 36.871430 $2653.2700 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 2 3 13.142857 $945.7600 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 2.285714 $164.4800 $71.9600
TRAV -TRAVS Travel by mile 3 4 76.000000 $33.8200 $0.4500
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Subtotal (Total Children Is Unduplicated) 435 1603 3764.709781 $281955.3000 $74.8900
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Total 2324 4939.788455 $357282.9900 $72.3300
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Number of Children (Unduplicated) With at Least One Authorization 573