Summary Report for FSPSAs Initiated During the Report Period Center: 02
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: 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 2637 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 5.211111 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 4 4 5.211111 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 35 39 7.190638 $348.7400 $48.5000
EXIT -EXIT EXIT ASSESSMENT 69 69 50.139728 $2506.9800 $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
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 1 1 0.158904 $8.1100 $51.0500
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 0.043836 $2.2400 $51.0100
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1 1 0.158904 $8.1100 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 5 6 1.210655 $61.8000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 3 3 0.698249 $35.6500 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 2 2 0.317808 $16.2200 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.166667 $8.5100 $51.0600
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 0.205479 $10.4900 $51.0600
PSTH -97161 PT EVAL LOW COMPLEXITY 2 3 0.661644 $33.7700 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 4 4 0.846575 $43.2200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 8 8 1.634018 $83.4200 $51.0500
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Subtotal (Total Children Is Unduplicated) 158 213 99.727607 $5575.7100 $55.9100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 13 17 3.177243 $15885.5000 $4999.7700
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 86 106 19.364381 $968.1600 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 233 274 389.769187 $19488.4600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 0.550000 $13.7500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 85 97 141.250000 $7062.5000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 56 57 80.300001 $4015.0100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 178 185 250.933331 $12546.6600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.666667 $16.6700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 51 51 266.398948 $13319.9600 $50.0000
INTR -T1013 INTERPRETER 18 25 57.790460 $2889.5100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 330 527 1778.136462 $17781.3500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 25 27 182.642857 $13047.9900 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 21 21 171.928570 $12282.5800 $71.4400
SENS -V5264 EARMOLD 1 1 0.317808 $5.7200 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 38 42 269.442853 $19249.0000 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 8.714286 $120.9500 $13.8800
TRAV -TRAVS Travel by mile 420 986 122492.461538 $54509.1600 $0.4500
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Subtotal (Total Children Is Unduplicated) 442 2420 126113.844592 $193202.9100 $1.5300
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Total 2637 126218.783310 $198778.6200 $1.5700
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Number of Children (Unduplicated) With at Least One Authorization 475