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: 04-01-17 and 06-30-17 Date of Report: 08-05-17 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 1627 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 5 5 1.611110 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 3 3 13.095238 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 8 8 14.706348 $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 44 45 37.462699 $807.3200 $21.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.127778 $2.6400 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.755556 $34.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 0.394825 $45.4000 $114.9900
EXIT -EXIT EXIT ASSESSMENT 7 8 9.750000 $487.5000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 0.127778 $9.5900 $75.0100
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 7 13 7.166666 $537.5000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 29 57 24.611115 $1845.8600 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.294444 $22.0800 $74.9900
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 12 19 10.499207 $787.4400 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 33 59 34.126193 $1894.0100 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 7 7 12.285714 $681.8600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 3 3 5.000000 $375.0000 $75.0000
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Subtotal (Total Children Is Unduplicated) 95 219 144.601975 $7627.2000 $52.7500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 6 2.333333 $11666.5000 $4999.9300
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 3 1.522222 $76.1100 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 19 19 7.955557 $1829.8100 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 51 63 63.270634 $3163.5300 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 139 185 173.764736 $8688.2600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 3 1.622222 $40.5600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2 2 1.811111 $90.5600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2 2 2.533333 $126.6700 $50.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 9 11 15.988889 $1172.3100 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 13 16 50.376192 $1259.4100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 398 456 2256.268271 $112813.3900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 418 629 2401.930621 $24019.3000 $10.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.372603 $84.9500 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
1 1 0.022222 $10.1200 $455.5500
SENS -V5264 EARMOLD 2 2 2.288889 $41.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 2.600000 $185.7400 $71.4400
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Subtotal (Total Children Is Unduplicated) 440 1400 4984.660835 $165268.4100 $33.1600
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Total 1627 5143.969158 $172895.6100 $33.6100
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Number of Children (Unduplicated) With at Least One Authorization 454