Summary Report for FSPSAs Initiated During the Report Period Center: 53
This report shows the total number of units/fees for FSPSAs initiated during the report period.
(i.e., start 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 starting 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 860 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 0.511111 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 3.933333 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 2 4.444444 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 0.305556 $14.8200 $48.5100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 1.016666 $21.9100 $21.5500
EXIT -EXIT EXIT ASSESSMENT 2 2 2.266667 $113.3400 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 1.394445 $104.5900 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 9 9 3.400000 $255.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.105556 $7.9200 $75.0300
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 5 5 1.116667 $83.7500 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 10 11 6.911110 $383.5600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 0.027778 $2.0900 $75.0600
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Subtotal (Total Children Is Unduplicated) 19 36 16.544445 $986.9700 $59.6600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.111111 $25.5500 $229.9800
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 36 39 28.964285 $1448.2200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 7 7 4.505556 $112.6400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 107 141 164.330557 $8216.5400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 3 1.561111 $39.0300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2 2 1.927777 $96.3900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1 1 1.500000 $75.0000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1 1 0.133333 $6.6700 $49.9900
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 0.255556 $18.7400 $73.3300
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 2.388889 $59.7200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 34 37 148.728573 $7436.4200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 421 586 2413.750807 $24137.4800 $10.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.133333 $8.6600 $64.9800
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Subtotal (Total Children Is Unduplicated) 434 822 2769.290888 $46681.0500 $16.8600
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Total 860 2790.279777 $47668.0200 $17.0800
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Number of Children (Unduplicated) With at Least One Authorization 435