Summary Report for FSPSAs Ending During the Report Period Center: 02
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 2395 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 5.857143 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1 1 5.857143 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 26 27 6.134171 $297.5000 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.013699 $0.3000 $21.5500
EXIT -EXIT EXIT ASSESSMENT 74 74 133.524659 $6676.2400 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 3 3 4.005479 $222.3100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 11 11 8.038353 $602.8900 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 8 8 10.016437 $751.2400 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 24 24 24.065748 $1335.6600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 28 28 36.547942 $2741.1100 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.054795 $2.8000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 2 2 0.750000 $38.2900 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 2 2 0.455556 $23.2600 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 4 4 1.408219 $71.8900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 2 0.600000 $30.6300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 7 7 2.041174 $104.2100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 1 1 0.205556 $10.5000 $51.0600
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.038356 $1.9200 $50.0600
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 162 197 229.900144 $13060.7200 $56.8100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 6 2.689878 $13449.5000 $5000.0400
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 59 63 20.489294 $1024.4600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 2.344444 $58.6100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 227 258 405.402381 $20270.1200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 7 7 8.616667 $215.4200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 86 90 142.459526 $7122.9900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.400000 $35.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 34 34 51.766667 $2588.3400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.866667 $21.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 173 185 270.900001 $13545.0100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 2.033334 $50.8400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 46 49 268.979367 $13448.9700 $50.0000
INTR -T1013 INTERPRETER 29 45 66.773765 $3338.6900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 312 466 1755.376293 $17553.7500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 16 16 139.000001 $9930.1500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 12 12 105.380952 $7528.4100 $71.4400
SENS -V5264 EARMOLD 1 1 0.443836 $7.9900 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 28 30 175.428571 $12532.6200 $71.4400
TRAV -TRAVS Travel by mile 488 929 139344.195618 $62008.1700 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 507 2197 142764.547262 $184730.6900 $1.2900
-------------------------------------------------------------------------------------------------------------------------------------
Total 2395 143000.304549 $197791.4100 $1.3800
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 520