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: 01-01-16 and 03-31-16 Date of Report: 05-12-16 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 3016 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 0.038889 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1 1 0.038889 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 36 37 6.123364 $296.9800 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 4 4 0.455327 $9.9900 $21.9500
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.433333 $67.0800 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.235616 $28.1800 $119.5900
EVAL -96111 DEVELOPMENTAL EVALUATION 8 9 1.005480 $50.2700 $49.9900
EXIT -EXIT EXIT ASSESSMENT 60 60 13.662178 $683.1000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 6 6 0.032874 $2.4800 $75.2900
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 0.010958 $0.8300 $75.2900
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 0.511111 $38.3300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 10 10 0.054944 $3.0500 $55.5500
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 143 143 0.924990 $69.5300 $75.1700
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 20 20 0.243829 $18.3200 $75.1100
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 177 178 2.514094 $139.6700 $55.5500
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 19 19 0.095884 $7.2100 $75.1700
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 6 6 1.417211 $72.3500 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 13 13 3.293381 $168.1300 $51.0500
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 2 2 0.389041 $58.3500 $149.9800
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 8 8 1.933639 $98.7100 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 19 19 3.362253 $171.6500 $51.0500
SCREEN-T1023 SCREENING 7 8 1.553119 $77.6600 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 18 18 2.609284 $133.1900 $51.0400
VISF -92499 VISION EVALUATION FUNCTIONAL 2 2 0.169863 $8.5000 $50.0100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 299 568 42.031773 $2203.5500 $52.4300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 39 40 6.899697 $34499.5000 $5000.1500
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.041096 $2.0600 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 68 80 13.159715 $657.9400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 3 4.269406 $106.7300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 189 377 565.545056 $28277.3300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 4 8.866666 $221.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1 1 0.050000 $2.5000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 14 14 9.366668 $468.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 2.233333 $55.8300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 25 26 837.714282 $20942.8700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 214 224 1446.387287 $72319.4000 $50.0000
INTR -T1013 INTERPRETER 18 25 10.690739 $534.5500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 325 567 1964.608423 $19646.0700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 57 59 468.209525 $33448.9100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 2.766667 $158.2600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 75 80 509.541089 $36401.6800 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 0.156164 $8.9300 $57.1700
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.235616 $55.8700 $237.1000
SENS -V5264 EARMOLD 1 1 0.235616 $4.2400 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 100 106 752.120541 $53731.5500 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 4.285714 $245.1400 $57.2000
TRAV -TRAVS Travel by mile 364 834 98120.850445 $43663.7900 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 413 2447 104728.233745 $345453.1300 $3.3000
-------------------------------------------------------------------------------------------------------------------------------------
Total 3016 104770.304407 $347656.6800 $3.3200
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 427