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 1417 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 27 27 31.034921 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 27 27 31.034921 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 2.000000 $150.0000 $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 2 2 2.500000 $187.5000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $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 3.500000 $262.5000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 2.000000 $150.0000 $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 6 6 9.500000 $527.2500 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 3 3 5.500000 $305.2500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 11 11 22.000000 $1650.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 37 37 70.505479 $5287.9100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 4 4 8.000000 $600.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 20 20 37.005479 $2775.4100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 11 11 19.500000 $1462.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 28 29 55.405479 $4155.4100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 35 35 65.500000 $3635.2500 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 47 47 86.916437 $4823.8700 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 3 3 0.850000 $43.7000 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 2 2 0.233333 $11.9900 $51.4000
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.4100 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 0.158904 $8.1700 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 0.361111 $18.5600 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.027778 $1.4300 $51.4500
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Subtotal (Total Children Is Unduplicated) 123 230 408.964000 $27298.4400 $66.7500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 3.000000 $15000.0000 $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 71 72 76.503970 $3825.2000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 90 103 74.934118 $3746.6700 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 44 55 34.040470 $1701.9900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 151 162 135.130149 $6756.4600 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 80 87 94.340475 $4717.0200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.272222 $31.8100 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 6 6 39.857143 $1992.8600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 83 91 455.545236 $22777.2800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 11 12 50.615873 $2530.7900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2 3 3.000000 $30.0000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 5 6 29.785714 $2143.3800 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 5 5 19.499999 $1403.2300 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 3 3 12.857142 $925.2000 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 5 5 17.285713 $1243.8900 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 4.428571 $318.6800 $71.9600
TRAV -TRAVS Travel by mile 3 4 76.000000 $33.8200 $0.4500
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Subtotal (Total Children Is Unduplicated) 373 1160 1671.434883 $96082.3500 $57.4800
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Total 1417 2111.433804 $123380.7800 $58.4300
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Number of Children (Unduplicated) With at Least One Authorization 451