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: 01-01-23 and 03-31-23 Date of Report: 04-20-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 1966 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 2.966667 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 2 2.966667 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 13 13 6.488813 $314.7100 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $14.6800 $14.6800
EXIT -EXIT EXIT ASSESSMENT 16 16 18.000000 $900.0000 $50.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 11 11 21.000000 $1575.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 11 11 22.000000 $1650.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 5 5 10.000000 $750.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 4 4 8.000000 $600.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 28 31 61.500000 $3413.2500 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 3 3 6.000000 $333.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 7 7 14.000000 $1050.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 6 6 11.500000 $862.5000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 2.000000 $102.8200 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 2 2 2.000000 $102.8200 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 5 5 2.301066 $118.3000 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
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Subtotal (Total Children Is Unduplicated) 81 120 190.789879 $12099.4900 $63.4200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 13.430158 $67150.5000 $4999.9800
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.180822 $9.0400 $49.9900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 34 35 32.472717 $1623.6300 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 4 4 6.005556 $300.2800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 1.966667 $49.1700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 185 206 326.183687 $16309.1600 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 0.300000 $15.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 83 88 145.782191 $7289.1100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.300000 $7.5000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 19 19 27.366665 $1368.3300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 165 171 274.288446 $13714.3800 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 1 1 0.066667 $3.3400 $50.0200
CONSP -CONSP CONSULT, SLP, PHONE 2 2 3.133334 $78.3400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 2 2 16.857143 $842.8600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 36 36 250.661906 $12533.1000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 4 4 9.785715 $489.2900 $50.0000
INTR -T1013 INTERPRETER 31 53 118.785715 $5939.2900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 275 524 1906.881684 $19068.8100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 4 47.571429 $3423.2500 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 2 2 8.571428 $616.8100 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 5 5 10.428572 $750.4400 $71.9600
TRAV -TRAVS Travel by mile 347 680 105082.373515 $46761.6600 $0.4500
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Subtotal (Total Children Is Unduplicated) 388 1844 108283.394017 $198343.2200 $1.8300
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Total 1966 108477.150563 $210442.7100 $1.9400
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Number of Children (Unduplicated) With at Least One Authorization 407