Summary Report for FSPSAs Initiated During the Report Period Center: 07
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 815 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 14.400795 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 4 4 14.400795 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 41 41 18.909743 $945.4800 $50.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 0.002740 $0.1500 $54.6700
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 4 4 2.016437 $151.2400 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 5 5 6.167123 $342.2700 $55.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1 1 0.494444 $25.2400 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 1.000000 $51.0500 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 2.000000 $102.1000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 8 8 6.659121 $339.9400 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 3 3 0.972223 $49.6400 $51.0500
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Subtotal (Total Children Is Unduplicated) 64 67 39.221831 $2058.1600 $52.4700
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 0.496043 $24.8000 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.966667 $231.2300 $239.2100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 123 134 56.080241 $2804.0700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 4 5.477777 $136.9400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 187 294 764.102041 $38205.1100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 7 10 16.600000 $415.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 8 8 56.995239 $2849.7600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 4 4 11.280953 $564.0500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 15 15 87.061906 $4353.1000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 4.000000 $100.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 165 184 1392.885711 $69644.3000 $50.0000
INTR -T1013 INTERPRETER 7 7 54.285714 $2714.2800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 3 3 30.857143 $2204.4400 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 5 7 49.428571 $3531.1800 $71.4400
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 1 1 2.000000 $948.4800 $474.2400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 16 16 92.571430 $6613.3000 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 3.142857 $43.6200 $13.8800
TRAV -TRAVS Travel by mile 42 50 297.361902 $132.3300 $0.4400
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Subtotal (Total Children Is Unduplicated) 397 744 2925.594195 $135515.9800 $46.3200
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Total 815 2979.216821 $137574.1400 $46.1800
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Number of Children (Unduplicated) With at Least One Authorization 426