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 1071 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 5 6 4.838889 $234.6900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 2.571429 $132.0400 $51.3500
OCTH -97167 OT EVAL HIGH COMPLEXITY 9 10 2.055555 $104.9300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 13 14 2.966667 $151.4500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 10 11 2.261113 $115.4400 $51.0500
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Subtotal (Total Children Is Unduplicated) 29 42 14.693653 $738.5500 $50.2600
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 10 10 3.249999 $162.5000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1 1 0.055556 $2.7800 $50.0400
CONSF -CONSF CONSULT, SLP, FACE TO FACE 6 6 1.094444 $54.7200 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 3 3 13.571428 $339.2900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 102 110 703.980947 $35199.0800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 648 764 5222.872987 $52228.7700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 10 11 38.703173 $2764.9600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 13 14 79.285714 $5664.1800 $71.4400
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 9 10 55.428570 $3959.8200 $71.4400
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Subtotal (Total Children Is Unduplicated) 691 1019 6139.142820 $101489.5000 $16.5300
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Total 1071 6158.786472 $102228.0500 $16.6000
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Number of Children (Unduplicated) With at Least One Authorization 701