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: 01-01-23 and 03-31-23 Date of Report: 04-20-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2161 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 4.541270 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 2 4.541270 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 16 17 6.649619 $322.5100 $48.5000
EXIT -EXIT EXIT ASSESSMENT 16 16 24.428571 $1221.4300 $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 3 3 2.122222 $109.1000 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 2.566667 $131.9500 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 0.183562 $9.4400 $51.4200
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 10.285714 $528.7900 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 2 3 3.000000 $154.2300 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 0.202740 $10.4200 $51.4000
SPCH -92521 EVAL OF SPEECH FLUENCY 5 6 3.069482 $157.8000 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 0.309589 $15.9100 $51.4000
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Subtotal (Total Children Is Unduplicated) 85 131 210.818166 $13156.3300 $62.4100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 12.990476 $64952.5000 $5000.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 45 45 39.464387 $1973.2300 $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 1 1 0.044444 $1.1100 $24.9800
CONIF -CONIF CONSULT, ITDS FACE TO FACE 193 212 348.769416 $17438.5100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 102 105 162.102485 $8105.1600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 3.766667 $94.1700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 15 16 23.128572 $1156.4300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 191 195 290.312276 $14515.6800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.266667 $31.6700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 13 13 101.685713 $5084.2900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 33 33 264.376190 $13218.8300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 5 5 38.357143 $1917.8600 $50.0000
INTR -T1013 INTERPRETER 30 52 107.071429 $5353.5700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 262 553 2050.686423 $20506.8800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 3 4 52.428571 $3772.7600 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 19.142857 $1377.5200 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 4 5 55.142857 $3968.0800 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 7 8 66.428572 $4780.1900 $71.9600
TRAV -TRAVS Travel by mile 321 769 121710.615209 $54161.2300 $0.4500
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Subtotal (Total Children Is Unduplicated) 343 2028 125353.785910 $222709.9100 $1.7800
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Total 2161 125569.145346 $235866.2500 $1.8800
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Number of Children (Unduplicated) With at Least One Authorization 365