Summary Report for FSPSAs Initiated During the Report Period Center: 01
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: 10-01-23 and 12-31-23 Date of Report: 01-14-24 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 4495 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 54 55 104.811906 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 54 55 104.811906 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 25 26 32.729421 $1587.3800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 5 5 5.000000 $280.5000 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 2 2 12.571429 $199.1300 $15.8400
EXIT -EXIT COS Exit 89 92 66.028769 $3301.4300 $50.0000
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 3 3 6.000000 $450.0000 $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 6 6 12.000000 $900.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 9 9 18.000000 $1350.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 3 3 6.000000 $450.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 20 20 39.000000 $2164.5000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 8 9 18.000000 $999.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 23 31 61.000000 $4575.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 3 3 6.000000 $450.0000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 2.000000 $102.8200 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 4 4 5.000000 $257.0500 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 6.857143 $352.5200 $51.4100
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $51.4100 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 0.933333 $47.9800 $51.4100
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Subtotal (Total Children Is Unduplicated) 172 221 303.120095 $17831.1300 $58.8300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 6 3.783105 $18915.5000 $4999.9900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 356 408 438.060874 $21903.0500 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 49 55 34.065075 $1703.2300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 34 35 33.022146 $825.5500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 212 227 497.362696 $24868.1300 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 12 12 33.200000 $1660.0000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 9 10 8.233334 $205.8400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 85 86 189.611110 $9480.5500 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 10 10 33.665080 $1683.2600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.533333 $38.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 78 82 167.083334 $8354.1700 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 7 7 15.400000 $770.0000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 2.066666 $51.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 136 138 285.045234 $14252.2500 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 10 10 15.999999 $800.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 7 15.866666 $396.6700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 14 15 140.333336 $7016.6700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 66 72 476.704768 $23835.2300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 24 29 207.933335 $10396.6600 $50.0000
INTR -T1013 INTERPRETER 148 221 358.464285 $17923.2200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1041 1344 9070.728666 $108848.7000 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 9 9 45.976192 $3308.4500 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 12 12 74.723810 $5377.1200 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 2 2 34.714286 $2498.0400 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 2 2 10.533333 $757.9800 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 17 17 124.933335 $8990.1900 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 21.428571 $1542.0000 $71.9600
TRAV -TRAVS Travel by mile 1061 1398 9134.538192 $4064.8800 $0.4500
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Subtotal (Total Children Is Unduplicated) 1169 4219 21475.010761 $300467.3000 $13.9900
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Total 4495 21882.942762 $318298.4300 $14.5500
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Number of Children (Unduplicated) With at Least One Authorization 1297