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 2552 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 29 33 5.035694 $244.2300 $48.5000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 25.428571 $2924.2900 $115.0000
EXIT -EXIT EXIT ASSESSMENT 54 54 31.309590 $1565.4800 $50.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 0.005479 $0.4100 $75.2900
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 27 27 12.110952 $908.3500 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 7 7 6.021916 $451.6500 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 24 24 16.083557 $892.6500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 14 14 2.069858 $155.2600 $75.0100
NURS -T1001 NURSING ASSESSMENT 1 1 0.002740 $0.1400 $49.2700
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 4 4 1.435616 $73.2900 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 0.307154 $15.6800 $51.0400
PSTH -97001 EVAL BY LICENSED PT, INITIAL 5 5 0.551370 $28.1500 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.222222 $11.3400 $51.0400
SCREEN-T1023 SCREENING 5 6 1.432800 $71.6400 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 7 7 2.452055 $125.1700 $51.0500
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Subtotal (Total Children Is Unduplicated) 137 187 104.469574 $7467.7200 $71.4800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 11 17 2.504946 $12523.0000 $4999.3100
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 213 265 394.398554 $19719.9200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 8 8 16.419047 $410.4800 $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 155 164 235.215081 $11760.7700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 4 3.633334 $90.8400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 49 50 240.776192 $12038.8200 $50.0000
INTR -T1013 INTERPRETER 17 22 54.859997 $2742.9900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 333 536 1861.533687 $18615.3100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 20 23 154.142862 $11011.9500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 25 26 118.809199 $8487.7300 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 55 61 472.123876 $33728.5200 $71.4400
TRAV -TRAVS Travel by mile 494 939 122860.757150 $54673.0400 $0.4500
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Subtotal (Total Children Is Unduplicated) 514 2357 126601.440582 $194845.4800 $1.5400
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Total 2552 126712.121267 $202313.1900 $1.6000
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Number of Children (Unduplicated) With at Least One Authorization 527