Summary Report for FSPSAs Ending During the Report Period Center: 06
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 1390 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 55 57 70.693650 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 55 57 70.693650 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 15 15 30.000000 $1500.0000 $50.0000
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 1.000000 $15.0000 $15.0000
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Subtotal (Total Children Is Unduplicated) 17 17 32.000000 $1566.0500 $48.9400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.011111 $50.5600 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 178 192 12.021924 $601.4000 $50.0200
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 12 13 0.951391 $23.7900 $25.0100
CONIF -CONIF CONSULT, ITDS FACE TO FACE 25 25 26.550003 $1327.5200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 16 18 15.766666 $394.1700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 6 7 6.766667 $338.3400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 5 5 1.150000 $28.7500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 9 9 7.908333 $395.4200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 5 5 5.550000 $138.7500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 21 21 27.475001 $1373.7600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 14 14 11.149999 $278.7500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 43 47 234.119044 $11705.9500 $50.0000
INTR -T1013 INTERPRETER 20 21 55.201869 $2760.1000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 667 859 4775.738888 $47757.4100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 15 15 54.717856 $3909.0500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 2.464286 $140.9600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 18 19 61.304761 $4379.6100 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 2 0.350685 $22.8000 $65.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 27 29 132.192855 $9443.8600 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 12 12 255.357146 $3544.3500 $13.8800
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Subtotal (Total Children Is Unduplicated) 710 1316 5688.748485 $93615.2500 $16.4600
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Total 1390 5791.442135 $95181.3000 $16.4300
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Number of Children (Unduplicated) With at Least One Authorization 758