Summary Report for FSPSAs Ending During the Report Period Center: 04
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 2173 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 4 5 2.066667 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 4 5 2.066667 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 12 12 3.933334 $190.7700 $48.5000
EVAL -96111 DEVELOPMENTAL EVALUATION 2 2 2.626027 $131.3000 $50.0000
NURS -T1001 NURSING ASSESSMENT 1 1 1.142857 $57.1500 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 7 7 1.927777 $98.4100 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 81 86 41.629366 $2125.1800 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 7 7 1.822222 $93.0200 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 76 81 31.196033 $1592.5600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 54 57 49.401587 $2521.9500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 5 5 0.866666 $44.2400 $51.0500
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Subtotal (Total Children Is Unduplicated) 187 258 134.545869 $6854.5800 $50.9500
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 2 0.700000 $35.0000 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.372222 $26.6500 $71.6100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 21 62 10.999997 $549.9900 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 7 7 9.186345 $459.3200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 2.577778 $128.8900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1 1 19.714286 $985.7200 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 100 116 699.999996 $17500.0100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 631 691 4213.755995 $210687.6600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 603 683 4110.764260 $41107.6100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 106 121 656.827783 $46923.7600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 4 4 29.714287 $1699.6600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 100 108 639.357152 $45675.6200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 5 5 20.857144 $1192.1900 $57.1600
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 1 2 0.700000 $331.9700 $474.2400
SENS -V5264 EARMOLD 1 2 0.700000 $12.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 90 102 505.000002 $36077.1600 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 11.000000 $629.2000 $57.2000
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Subtotal (Total Children Is Unduplicated) 813 1910 10932.227247 $404022.9900 $36.9600
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Total 2173 11068.839783 $410877.5700 $37.1200
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Number of Children (Unduplicated) With at Least One Authorization 817