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: 04-01-23 and 06-30-23 Date of Report: 07-25-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2096 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 1 1 2.466667 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 2.466667 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 24 24 13.800227 $669.3100 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $14.6800 $14.6800
EXIT -EXIT EXIT ASSESSMENT 24 24 30.712264 $1535.6200 $50.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
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 12 12 18.016437 $1351.2400 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 5 5 10.000000 $750.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 4 4 8.000000 $600.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 4 4 8.000000 $600.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 19 21 35.016437 $1943.4200 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 5 6 10.000000 $750.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 5 5 9.000000 $675.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.566667 $28.3400 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 4 4 2.733333 $140.5200 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.032877 $1.6900 $51.4500
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 0.082192 $4.2300 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 0.338889 $17.4200 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 1.033333 $53.1200 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 2.000000 $102.8200 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 3 4 3.066667 $157.6600 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 0.164384 $8.4500 $51.4100
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Subtotal (Total Children Is Unduplicated) 88 127 161.563707 $9886.5100 $61.1900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 6 2.766667 $13833.5000 $5000.0600
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 47 49 54.486197 $2724.3300 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 5 5 3.019445 $150.9800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 0.772222 $19.3100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 198 217 320.219047 $16010.9400 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 1 1 0.700000 $35.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 104 109 161.933334 $8096.6700 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 1 1 0.400000 $20.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.066667 $26.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 17 17 22.000000 $1100.0000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 184 193 275.766669 $13788.3500 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 2.433333 $121.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 2.466666 $61.6700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 7 7 37.023809 $1851.2000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 52 55 378.885721 $18944.2600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 7.428571 $371.4300 $50.0000
INTR -T1013 INTERPRETER 14 21 29.343704 $1467.1800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 277 546 1897.111049 $22765.3100 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 4 22.285715 $1603.6800 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 8.571429 $616.8000 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 5 5 26.857144 $1932.6400 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 4 41.428572 $2981.1900 $71.9600
TRAV -TRAVS Travel by mile 354 719 107895.804433 $48013.6300 $0.4500
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Subtotal (Total Children Is Unduplicated) 387 1968 111193.770394 $156605.7200 $1.4100
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Total 2096 111357.800768 $166492.2300 $1.5000
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Number of Children (Unduplicated) With at Least One Authorization 397