Summary Report for FSPSAs Ending During the Report Period Center: 02
This report shows the total number of units/fees for FSPSAs ending during the report period.
(i.e., end 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 ending between: 07-01-24 and 09-30-24 Date of Report: 04-06-25 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2081 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 2 2 1.744444 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 2 1.744444 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 33 33 20.286986 $983.9200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 1.175342 $72.5300 $61.7100
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.283333 $4.5800 $16.1500
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.123288 $5.5900 $45.3200
EXIT -EXIT COS Exit 11 11 10.002740 $500.1400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 5 7 14.000000 $1050.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 3 4.005479 $324.3700 $80.9800
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $161.9600 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 0.005479 $0.3300 $60.1600
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 1 2.000000 $119.8400 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 80 80 138.054790 $11179.6900 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 19 19 36.005556 $2915.7300 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 46 47 88.500000 $7166.7300 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 21 22 44.000000 $3563.1200 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 91 92 159.054790 $9530.5800 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 26 26 52.000000 $3115.8400 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 62 85 165.500000 $13402.1900 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 12 21 42.000000 $3401.1600 $80.9800
OCTF -97168 OT RE-EVAL EST PLAN CARE 4 4 0.792314 $46.0400 $58.1100
OCTF -97168GT OT RE-EVAL EST PLAN CARE 1 1 0.016438 $0.9500 $57.9800
OCTH -97165 OT EVAL LOW COMPLEXITY 34 35 38.879081 $2259.2600 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 3 3 3.888889 $225.9800 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 11 11 2.493912 $144.9300 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 0.087671 $5.1000 $58.1300
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 0.255556 $14.8500 $58.1200
PSTF -97164 PT RE-EVAL EST PLAN CARE 3 3 2.988889 $173.6900 $58.1100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 2 2 0.257534 $14.9700 $58.1200
PSTH -97161 PT EVAL LOW COMPLEXITY 27 28 10.845434 $630.2400 $58.1100
PSTH -97161GT PT EVAL LOW COMPLEXITY 3 3 3.888889 $225.9800 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 4 5 3.460274 $201.0800 $58.1100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 0.079452 $4.6200 $58.1400
SPCH -92521 EVAL OF SPEECH FLUENCY 47 50 23.454870 $1362.9700 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 1.000000 $58.1100 $58.1100
SPCH -92522 EVAL OF SPCH SOUND PROD 9 10 2.241781 $130.2700 $58.1100
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 0.172603 $10.0300 $58.1100
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 -0.005479 $-0.3200 $58.3300
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 14 14 9.909132 $575.8200 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.244444 $14.2000 $58.1000
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.366667 $21.3100 $58.1200
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Subtotal (Total Children Is Unduplicated) 321 630 884.316134 $63618.3600 $71.9400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 34 34 98.031866 $490159.5000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 70 72 78.862990 $3943.1300 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 13 13 15.250000 $762.5000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 200 235 391.938084 $19596.8500 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 4 4 7.899999 $395.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 103 110 206.014280 $10300.7000 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 1 1 1.800000 $90.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 2.133333 $53.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 4 5 5.499999 $275.0000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 3.133333 $78.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 185 196 377.528564 $18876.3900 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 2.233333 $111.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 10.376190 $259.4100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 192 207 1348.190472 $72802.3200 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 21 22 135.857143 $7336.2800 $54.0000
INTR -T1013 INTERPRETER 23 33 59.414773 $2970.7500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 76 134 412.223802 $4946.6900 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 69 71 523.971426 $42609.3400 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 5.000000 $406.6000 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 38 39 283.285715 $23036.7800 $81.3200
PHY -97110HM PT SESSION BY PT ASST 7 7 68.285713 $4446.7700 $65.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 82 86 592.396823 $48173.7100 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 10.000000 $813.2000 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 -0.285714 $-23.2300 $81.3200
TRAV -TRAVS Travel by mile 78 167 21979.259621 $9780.7700 $0.4500
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Subtotal (Total Children Is Unduplicated) 313 1449 26618.301745 $762201.7700 $28.6300
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Total 2081 27504.362323 $825820.1300 $30.0300
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Number of Children (Unduplicated) With at Least One Authorization 473