Summary Report for FSPSAs Ending During the Report Period Center: 01
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: 10-01-17 and 12-31-17 Date of Report: 02-03-18 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 4624 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 42 44 56.684129 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 42 44 56.684129 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 22 24 87.544216 $4245.8900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $51.3500 $51.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.180822 $2.2800 $12.6100
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.180822 $1.4900 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.180822 $4.5800 $25.3100
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 0.180822 $3.3500 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.180822 $3.7400 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.266667 $12.0000 $45.0100
EXIT -EXIT EXIT ASSESSMENT 187 190 380.000000 $19000.0000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 4 4 4.010958 $300.8300 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 3 3 4.005479 $300.4100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 14 14 20.016437 $1501.2400 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 4 4 6.500000 $487.5000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 3 3 5.000000 $375.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 32 32 54.516437 $3025.6700 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 14 14 26.000000 $1950.0000 $75.0000
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 0.084932 $4.3300 $51.0300
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 3 2.090411 $106.7100 $51.0500
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.533333 $8.0000 $15.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 245 304 597.472980 $31648.5300 $52.9700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 7 2.350305 $11751.5000 $4999.9900
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 8 9 2.533333 $126.6700 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 264 297 301.033586 $15051.6600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 2.500000 $62.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 106 131 192.147704 $9607.3800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 3 53.500000 $1337.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 21 24 36.262701 $1813.1500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.200000 $30.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 60 62 83.100795 $4155.0400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 2.500000 $62.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 86 99 136.393651 $6819.6800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.200000 $30.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 72 76 425.900001 $21295.0300 $50.0000
INTR -T1013 INTERPRETER 121 150 373.292857 $18664.6400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 986 1536 7587.902073 $75879.0200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 5 6 20.714286 $1479.8300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 10 11 52.396825 $3743.2300 $71.4400
RSPT -RSPT RESPITE 1 1 1.000000 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.169863 $11.0400 $65.0100
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.533333 $60.8000 $113.9900
SENS -V5264 EARMOLD 2 2 0.703196 $12.6600 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 30 31 255.823808 $18276.0900 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 10.571429 $604.6800 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 11.142857 $154.6600 $13.8800
TRAV -TRAVS Travel by mile 1184 1823 17393.786128 $7740.2400 $0.4500
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Subtotal (Total Children Is Unduplicated) 1224 4276 26948.658731 $198769.4800 $7.3800
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Total 4624 27602.815840 $230418.0100 $8.3500
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Number of Children (Unduplicated) With at Least One Authorization 1257