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: 10-01-16 and 12-31-16 Date of Report: 02-04-17 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
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 29 31 13.917723 $675.0100 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.079452 $1.1900 $14.9400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.079452 $0.8300 $10.4300
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 0.334246 $7.3400 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.079452 $0.7000 $8.7500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.079452 $1.7400 $21.8500
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 0.079452 $1.8200 $22.9100
EVAL -96111 DEVELOPMENTAL EVALUATION 5 5 2.761643 $138.0800 $50.0000
EXIT -EXIT EXIT ASSESSMENT 54 55 33.688890 $1684.4600 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 0.016437 $1.2400 $75.2900
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 0.010958 $0.8300 $75.2900
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 1.005479 $55.8100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 29 30 23.594515 $1769.6100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 8 8 4.032874 $302.4800 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 34 35 30.104104 $1670.7900 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 15 15 10.047945 $753.6000 $75.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 2 2 0.719178 $36.7200 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 1 3 0.011036 $0.5600 $50.8800
PSTH -97001 EVAL BY LICENSED PT, INITIAL 7 7 1.025647 $52.3600 $51.0500
SCREEN-T1023 SCREENING 10 12 3.801827 $190.1000 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 3.274734 $167.1800 $51.0500
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Subtotal (Total Children Is Unduplicated) 151 221 128.744496 $7512.4100 $58.3500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 6 0.963318 $4816.5000 $4999.9100
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.079452 $3.9800 $50.0300
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.076712 $18.3500 $239.1600
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 61 69 21.963641 $1098.1700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 6 7 9.847507 $246.1900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 169 211 358.964604 $17948.2200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 8 10 25.238094 $630.9500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 42 48 73.353568 $3667.6700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.500000 $12.5000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 27 27 49.308331 $2465.4100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.166667 $29.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 124 131 222.180559 $11109.0500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 3.861111 $96.5300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 2 2 55.714285 $1392.8600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 43 49 277.656351 $13882.8200 $50.0000
INTR -T1013 INTERPRETER 11 17 30.214807 $1510.7500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 302 479 1787.519314 $17875.1600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 20 20 131.480951 $9393.0000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 27 27 212.671430 $15193.2400 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 42 44 301.480954 $21537.7900 $71.4400
TRAV -TRAVS Travel by mile 431 785 107084.289891 $47652.5100 $0.4500
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Subtotal (Total Children Is Unduplicated) 459 1940 110648.531547 $170580.7800 $1.5400
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Total 2161 110777.276043 $178093.1900 $1.6100
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Number of Children (Unduplicated) With at Least One Authorization 473