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 1017 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 1 1 0.500000 $10.7800 $21.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.127778 $2.6400 $20.6800
EXIT -EXIT EXIT ASSESSMENT 7 8 9.750000 $487.5000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 7 7 2.988889 $224.1700 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 27 29 9.188893 $689.2000 $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 11 11 5.460318 $409.5200 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 25 26 11.810320 $655.4800 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
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Subtotal (Total Children Is Unduplicated) 46 87 44.120642 $2709.3700 $61.4100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 0.611111 $3055.5000 $4999.9100
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.266667 $63.3400 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 1.788889 $411.4500 $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 138 183 173.698069 $8684.9300 $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 1 1 1.200000 $87.9800 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 3 5 17.147620 $428.6900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 28 29 178.101589 $8905.0800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 418 628 2399.497288 $23994.9700 $10.0000
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Subtotal (Total Children Is Unduplicated) 430 922 2842.548533 $49053.2300 $17.2600
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Total 1017 2901.375523 $51762.6000 $17.8400
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Number of Children (Unduplicated) With at Least One Authorization 439