Summary Report for FSPSAs Ending During the Report Period Center: 05
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 1973 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 42 42 47.561904 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 42 42 47.561904 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 5 5 6.000000 $450.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 9 9 16.011111 $1296.5800 $80.9800
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 11 11 17.022222 $1378.4600 $80.9800
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 0.011111 $0.9000 $80.9000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 2 2 3.500000 $283.4300 $80.9800
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 11 11 20.011111 $1620.5000 $80.9800
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 3 3 4.500000 $364.4100 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 16 16 23.488889 $1407.4500 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 21 22 32.022222 $1918.7700 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 76 78 152.500000 $12349.4500 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 71 71 138.000000 $11175.2400 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 5 5 10.000000 $809.8000 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 13 13 24.000000 $1943.5200 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 66 66 128.500000 $10405.9300 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 27 27 51.500000 $4170.4700 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 74 74 140.000000 $8388.8000 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 98 100 188.500000 $11294.9200 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 5 5 10.000000 $809.8000 $80.9800
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 0.087671 $5.1000 $58.1300
OCTH -97165 OT EVAL LOW COMPLEXITY 8 8 2.016666 $117.1800 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 0.055556 $3.2300 $58.1600
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.061111 $3.5500 $58.1000
OCTH -97167 OT EVAL HIGH COMPLEXITY 6 6 3.272223 $190.1500 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 2 1.288889 $74.9000 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 18 19 16.805556 $976.5700 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 5 5 1.837975 $106.8100 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 0.044444 $2.5800 $58.0500
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 1 1 0.633333 $36.8000 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 19 20 16.466666 $956.8700 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 1.000000 $58.1100 $58.1100
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 2.000000 $116.2200 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 17 18 9.103121 $528.9900 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.005556 $58.4400 $58.1100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.255556 $14.8500 $58.1200
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.405556 $23.5700 $58.1200
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 2.000000 $116.2200 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 4 4 22.590476 $1312.7300 $58.1100
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Subtotal (Total Children Is Unduplicated) 337 614 1048.497021 $74933.2700 $71.4700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 13 13 11.134247 $55671.5000 $5000.0200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 40 45 34.905556 $1745.2800 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 20 21 16.505556 $825.2800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.000000 $25.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 239 247 279.848809 $13992.4100 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 61 65 77.748412 $3887.4200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 68 73 69.084129 $3454.2100 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 36 38 46.535715 $2326.7900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 86 88 68.500791 $3425.0300 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 37 38 25.422225 $1271.1100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 140 144 138.545237 $6927.2500 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 75 76 74.667460 $3733.3700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 6 5.399999 $135.0000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 4 4 7.833333 $211.5000 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 258 274 1483.752372 $80122.6900 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 51 55 254.534921 $13744.9000 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 27 28 150.890475 $12270.4100 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 47 51 253.873810 $20645.0400 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 4 4 18.214286 $1481.1900 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 1 1 6.285714 $511.1500 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 40 42 256.457144 $20855.1100 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 3 28.000001 $2276.9500 $81.3200
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Subtotal (Total Children Is Unduplicated) 364 1317 3309.140192 $249538.5700 $75.4100
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Total 1973 4405.199117 $324471.8400 $73.6600
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Number of Children (Unduplicated) With at Least One Authorization 627