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: 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 904 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
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Subtotal (Total Children Is Unduplicated) 1 1 0.533333 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 5 6 3.427777 $166.2400 $48.5000
EXIT -EXIT EXIT ASSESSMENT 4 4 4.250000 $212.5000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 1.511111 $113.3300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 0.638889 $47.9200 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 0.666666 $50.0000 $74.9900
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 6 6 2.794444 $155.0900 $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) 17 23 15.288887 $856.0800 $55.9900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 1.372222 $6861.0000 $4999.9200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 43 50 52.754761 $2637.7400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 2.000000 $50.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 114 151 174.612697 $8730.6300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 4 5.766667 $144.1700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 5 5 7.000000 $350.0000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 6 6 6.726191 $336.3200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 2.766667 $69.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2 2 5.066667 $253.3400 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 2 2 3.285714 $82.1400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 14 14 59.435714 $2971.7900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 429 639 2260.530164 $22605.2900 $10.0000
PHY -97110 PT SESSION BY LICENSED PT 1 1 0.522222 $37.3100 $71.4400
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) 437 880 2582.839686 $45200.3200 $17.5000
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Total 904 2598.661906 $46056.4000 $17.7200
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Number of Children (Unduplicated) With at Least One Authorization 439