Summary Report for FSPSAs Ending During the Report Period Center: 53
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 943 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 2 2 0.500000 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 3 3 7.507143 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 5 8.007143 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 0.266667 $12.9400 $48.5100
EXIT -EXIT EXIT ASSESSMENT 7 7 102.083333 $5104.1700 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 8 8 3.538890 $265.4300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 21 23 9.944444 $745.8300 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 0.388889 $29.1700 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 19 20 10.844444 $601.8600 $55.5000
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Subtotal (Total Children Is Unduplicated) 34 60 127.066667 $6759.3900 $53.2000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 2 0.055556 $278.0000 $5003.9600
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.511111 $25.5600 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 5 5 2.000000 $100.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 37 43 32.938888 $1646.9400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 134 170 201.651589 $10082.5800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 7 9 7.505556 $187.6400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2 2 3.033333 $151.6700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1 1 2.966667 $148.3400 $50.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 3.600000 $263.9500 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 2.200000 $55.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 27 31 118.114285 $5905.7300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 405 610 2469.157939 $24691.5900 $10.0000
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 2 2 1.255556 $572.5500 $456.0200
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Subtotal (Total Children Is Unduplicated) 411 878 2844.990480 $44109.5400 $15.5000
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Total 943 2980.064290 $50868.9200 $17.0700
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Number of Children (Unduplicated) With at Least One Authorization 416