Summary Report for FSPSAs Initiated During the Report Period Center: 53
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 1101 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 3 3 0.888889 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 3 7.142857 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 6 8.031746 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 2 2.000000 $97.0000 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 0.611111 $13.1700 $21.5500
EXIT -EXIT EXIT ASSESSMENT 7 7 8.205555 $410.2800 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 7 7 2.233334 $167.5100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 28 29 10.355555 $776.6600 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 19 19 4.405555 $330.4100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 39 40 14.250000 $790.8800 $55.5000
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Subtotal (Total Children Is Unduplicated) 56 106 42.061110 $2585.9000 $61.4800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.183333 $916.5000 $4999.1000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 0.944444 $47.2200 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 0.950000 $218.5000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 35 40 28.594444 $1429.7200 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 155 208 193.592864 $9679.6700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 7 7 2.761111 $69.0300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3 3 0.905556 $45.2800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1 1 0.027778 $1.3900 $50.0400
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1 1 2.433333 $121.6700 $50.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 0.100000 $7.3300 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 3 3 6.838096 $170.9500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 30 33 162.268254 $8113.4300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 462 687 2385.696031 $23856.9800 $10.0000
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Subtotal (Total Children Is Unduplicated) 472 989 2785.295244 $44677.6600 $16.0400
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Total 1101 2835.388100 $47263.5600 $16.6700
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Number of Children (Unduplicated) With at Least One Authorization 477