Summary Report for FSPSAs Initiated During the Report Period Center: 04
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: 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 2113 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 4 1.111111 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 4 4 1.111111 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 5 5 1.155556 $56.0500 $48.5000
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 0.126027 $6.3000 $49.9900
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 5 6 1.127779 $57.5800 $51.0600
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 88 91 45.595234 $2327.6200 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 3 3 0.866667 $44.2500 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 76 81 25.803173 $1317.2400 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 0.500000 $25.5300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 69 71 41.263970 $2106.5200 $51.0500
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Subtotal (Total Children Is Unduplicated) 198 260 116.438406 $5941.0700 $51.0200
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 3 1.405555 $70.2800 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 36 114 25.777768 $1288.8400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4 4 1.526027 $76.3000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3 3 2.855555 $142.7800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1 1 2.966667 $148.3400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4 4 23.958730 $1197.9400 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 95 109 589.857142 $14746.4300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 583 621 4314.967488 $215748.2100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 576 630 4310.854791 $43108.5100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 128 136 709.793655 $50707.5800 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 101 106 563.214292 $40235.9600 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 9.714286 $555.2700 $57.1600
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 1 1 0.344444 $163.3300 $474.1800
SENS -V5264 EARMOLD 1 1 0.344444 $6.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 109 115 527.642867 $37694.7900 $71.4400
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Subtotal (Total Children Is Unduplicated) 742 1849 11085.223711 $405890.7300 $36.6200
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Total 2113 11202.773228 $411831.8000 $36.7600
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Number of Children (Unduplicated) With at Least One Authorization 745