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: 07-01-17 and 09-30-17 Date of Report: 11-04-17 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 1114 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 1 1 0.533333 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 3 3.533333 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 3 4 4.066666 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 0.200000 $9.7000 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.216667 $4.6700 $21.5500
EXIT -EXIT EXIT ASSESSMENT 5 5 4.594444 $229.7200 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 13 13 4.244445 $318.3400 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 25 25 7.605559 $570.4400 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.483333 $36.2500 $74.9900
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 15 15 7.677779 $575.8400 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 27 27 8.916669 $494.8900 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 3.000000 $166.5000 $55.5000
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Subtotal (Total Children Is Unduplicated) 50 90 36.938896 $2406.3500 $65.1400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.711111 $3555.5000 $4999.9200
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.144444 $7.2200 $49.9800
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.005556 $1.2900 $231.8200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 48 55 99.484127 $4974.2100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 2.000000 $50.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 165 223 222.682647 $11134.1800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 8 8 3.194445 $79.8600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1 1 0.322222 $16.1100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 4 4 2.276190 $113.8100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.300000 $7.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3 3 6.833334 $341.6700 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 4 5 12.714285 $317.8600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 18 18 56.645236 $2832.2700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 439 696 2604.295333 $26042.9400 $10.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 1.000000 $71.4400 $71.4400
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Subtotal (Total Children Is Unduplicated) 451 1020 3012.608930 $49545.8600 $16.4500
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Total 1114 3053.614492 $51952.2000 $17.0100
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Number of Children (Unduplicated) With at Least One Authorization 454