Summary Report for FSPSAs Ending During the Report Period Center: 04
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 2587 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 10 10 4.949999 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 10 10 4.949999 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 6 7 4.861111 $235.7600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 2.715873 $139.4600 $51.3500
OCTH -97167 OT EVAL HIGH COMPLEXITY 136 144 56.699209 $2894.5000 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 0.266667 $13.6200 $51.0600
PSTH -97163 PT EVAL HIGH COMPLEXITY 111 115 43.473022 $2219.3300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 81 86 19.966670 $1019.3200 $51.0500
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Subtotal (Total Children Is Unduplicated) 260 355 127.982552 $6521.9900 $50.9600
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.200000 $10.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 28 79 16.622224 $831.1200 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 8 8 3.477778 $173.8900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 11 11 3.349999 $167.5000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 2.288889 $114.4500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 8 8 3.627777 $181.3900 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 100 116 636.999997 $15925.0200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 662 743 5101.054733 $255052.9400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 648 764 5222.872987 $52228.7700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 175 195 932.897625 $66646.2000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 16.714285 $956.0600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 138 148 745.071430 $53227.9400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 3 16.857144 $963.5500 $57.1600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
1 1 0.200000 $91.2000 $456.0000
SENS -V5264 EARMOLD 1 1 0.400000 $7.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 126 139 607.034131 $43366.5200 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 11.857143 $164.5800 $13.8800
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Subtotal (Total Children Is Unduplicated) 859 2222 13321.526142 $490108.3100 $36.7900
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Total 2587 13454.458693 $496630.2900 $36.9100
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Number of Children (Unduplicated) With at Least One Authorization 870