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: 01-01-17 and 03-31-17 Date of Report: 05-05-17 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 3470 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 8 8 6.211111 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 8 8 6.211111 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 41 46 7.216516 $350.0000 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 8 8 0.717504 $15.4600 $21.5500
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 0.200000 $3.7100 $18.5500
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.066667 $48.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 25.664187 $2951.3800 $115.0000
EXIT -EXIT EXIT ASSESSMENT 55 55 32.309590 $1615.4800 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 5 5 2.021916 $151.6500 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 0.005479 $0.4100 $75.2900
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 3 3 0.016437 $1.2400 $75.2900
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 132 132 75.786280 $5684.0600 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 57 57 53.654783 $4024.1500 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 159 159 111.836965 $6207.0100 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 67 67 15.802726 $1185.2600 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 0.002740 $0.1400 $49.2700
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 3 3 0.169863 $8.6700 $51.0600
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 18 18 7.039650 $359.3700 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 3 3 0.545510 $27.8500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.127778 $6.5200 $51.0600
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 3 3 0.301370 $15.3800 $51.0400
PSTH -97001 EVAL BY LICENSED PT, INITIAL 30 30 14.661590 $748.4800 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 3 3 0.534551 $27.2900 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.322222 $16.4500 $51.0500
SCREEN-T1023 SCREENING 5 6 1.432800 $71.6400 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.109589 $5.6000 $51.0600
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 24 25 6.476941 $330.6500 $51.0500
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Subtotal (Total Children Is Unduplicated) 359 635 360.023654 $23966.8300 $66.5700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 45 54 9.478158 $47389.0000 $4999.8100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 91 111 16.968872 $848.3900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 4 4 1.716666 $42.9200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 214 266 395.598554 $19779.9200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 8 9 17.776190 $444.4000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 60 73 103.283333 $5164.1700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 5 6 6.733333 $168.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 44 46 55.170009 $2758.4700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 2.394444 $59.8600 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 156 165 237.081748 $11854.1000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 4 3.633334 $90.8400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 23 25 618.571428 $15464.2900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 246 267 1449.076191 $72453.8000 $50.0000
INTR -T1013 INTERPRETER 17 22 54.859997 $2742.9900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 333 539 1869.471783 $18694.6900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 76 80 567.150686 $40517.2700 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 93 95 595.566344 $42547.2800 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 3 21.857142 $1249.3600 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 0.235616 $53.7200 $227.9800
SENS -V5264 EARMOLD 2 2 0.235616 $4.2400 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 99 109 784.052445 $56012.7000 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 5.714286 $79.3100 $13.8800
TRAV -TRAVS Travel by mile 494 942 123337.042864 $54884.9900 $0.4500
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Subtotal (Total Children Is Unduplicated) 537 2827 130153.669039 $393305.0200 $3.0200
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Total 3470 130519.903804 $417271.8500 $3.2000
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Number of Children (Unduplicated) With at Least One Authorization 558