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 1117 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 22 22 27.553306 $1336.3400 $48.5000
EXIT -EXIT COS Exit 2 2 2.000000 $100.0000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $161.9600 $80.9800
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 9 10 16.010958 $1296.5700 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 2 2 4.000000 $323.9200 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 6 6 12.000000 $971.7600 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 2 2 4.000000 $323.9200 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 17 17 30.010958 $1798.2600 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 4 5 10.000000 $599.2000 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 19 25 48.000000 $3887.0400 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $161.9600 $80.9800
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 0.272222 $15.8200 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 5 5 6.437693 $374.1000 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.305556 $17.7600 $58.1200
PSTH -97161 PT EVAL LOW COMPLEXITY 3 3 0.930290 $54.0700 $58.1200
SPCH -92521 EVAL OF SPEECH FLUENCY 6 6 2.391401 $138.9700 $58.1100
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 11.857143 $689.0200 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.305556 $75.8700 $58.1100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 69 113 183.075083 $12488.4900 $68.2200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 24.496825 $122484.0000 $4999.9900
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 207 230 368.952377 $18447.6000 $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 183 186 273.033329 $13651.6500 $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 60 60 376.642864 $20338.6800 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 4 4 34.999999 $1890.0100 $54.0000
INTR -T1013 INTERPRETER 14 22 37.293934 $1864.7000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 85 154 512.242863 $6146.9100 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 9 9 64.999998 $5285.8000 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 4 4 34.999999 $2846.2000 $81.3200
PHY -97110HM PT SESSION BY PT ASST 1 1 3.285714 $213.9600 $65.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 10 10 59.345650 $4825.9800 $81.3200
TRAV -TRAVS Travel by mile 51 128 11729.128573 $5219.4600 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 282 1004 13781.763037 $215949.4700 $15.6700
-------------------------------------------------------------------------------------------------------------------------------------
Total 1117 13964.838120 $228437.9500 $16.3600
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 303