Summary Report for FSPSAs Initiated During the Report Period Center: 02
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: 01-01-24 and 03-31-24 Date of Report: 04-04-25 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 1941 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
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 32 32 33.260155 $1613.1200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 2.837900 $175.1300 $61.7100
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 0.589878 $26.7300 $45.3200
EXIT -EXIT COS Exit 2 2 2.000000 $100.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 5 9.000000 $675.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 6.000000 $485.8800 $80.9800
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 4.000000 $323.9200 $80.9800
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 63 66 107.565748 $8710.6900 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 16 17 33.500000 $2712.8300 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 42 42 84.000000 $6802.3200 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 10 10 20.000000 $1619.6000 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 82 87 148.565748 $8902.0800 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 23 24 47.500000 $2846.2000 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 55 76 145.000000 $11742.1000 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 11 17 34.000000 $2753.3200 $80.9800
OCTF -97168 OT RE-EVAL EST PLAN CARE 4 4 1.042922 $60.6000 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 33 33 29.661080 $1723.6000 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 3 3 1.733333 $100.7200 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 11 11 1.974506 $114.7400 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 0.164384 $9.5500 $58.1200
OCTH -97167 OT EVAL HIGH COMPLEXITY 3 3 1.436301 $83.4600 $58.1100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 0.372222 $21.6300 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 2 0.911111 $52.9400 $58.1100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 1 1 0.164384 $9.5500 $58.1200
PSTH -97161 PT EVAL LOW COMPLEXITY 26 27 21.164188 $1229.8600 $58.1100
PSTH -97161GT PT EVAL LOW COMPLEXITY 3 3 1.733333 $100.7200 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 6 6 2.871689 $166.8700 $58.1100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 0.172603 $10.0300 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 47 48 18.351369 $1066.3900 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 1.000000 $58.1100 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 1.000000 $58.1100 $58.1100
SPCH -92522 EVAL OF SPCH SOUND PROD 7 7 13.639335 $792.5800 $58.1100
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 0.084932 $4.9300 $58.0900
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 14 14 10.308523 $599.0300 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.422222 $82.6400 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.127778 $7.4300 $58.1200
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Subtotal (Total Children Is Unduplicated) 254 558 787.155644 $55842.4400 $70.9400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 30 30 95.929027 $479645.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 62 63 66.593630 $3329.6500 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 9 10 9.604166 $480.2100 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 208 231 370.319044 $18515.9400 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 3 3 5.000000 $250.0000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 2.000000 $50.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 101 102 156.181213 $7809.0700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 2.466666 $61.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 4 4 5.666666 $283.3300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 5.000000 $125.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 185 188 274.399996 $13719.9800 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 1.566667 $78.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 5.833333 $145.8300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 2.428571 $121.4300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 205 208 1281.852407 $69219.9300 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 19 19 130.142857 $7027.7100 $54.0000
INTR -T1013 INTERPRETER 14 22 37.293934 $1864.7000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 85 155 515.671434 $6188.0600 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 69 69 471.551587 $38346.5500 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 9.571429 $778.3500 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 42 42 328.185713 $26688.0500 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 1 1 6.000000 $487.9200 $81.3200
PHY -97110HM PT SESSION BY PT ASST 4 4 19.285714 $1255.8800 $65.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 86 88 574.254382 $46698.3200 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 3 15.000000 $1219.8000 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 5.142857 $418.2200 $81.3200
TRAV -TRAVS Travel by mile 51 128 11729.128573 $5219.4600 $0.4500
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Subtotal (Total Children Is Unduplicated) 306 1383 16126.069866 $730028.3800 $45.2700
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Total 1941 16913.225510 $785870.8200 $46.4600
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Number of Children (Unduplicated) With at Least One Authorization 354