Summary Report for FSPSAs Ending During the Report Period Center: 57
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 3334 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 6 6 4.594445 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 4 4 2.566668 $94.9700 $37.0000
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Subtotal (Total Children Is Unduplicated) 10 10 7.161113 $94.9700 $13.2600
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 0.255556 $12.4000 $48.5100
AUDE -92585 AUD EVOKED RESPONSE (COMP) 2 2 0.355555 $27.4200 $77.1200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 1.000000 $75.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 12 12 19.857143 $1102.0700 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 11 11 18.857143 $1414.2800 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 29 30 12.845239 $655.7600 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 97 101 31.912697 $1629.1400 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 45 47 39.801588 $2031.8800 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.177778 $9.0800 $51.0600
PSTH -97163 PT EVAL HIGH COMPLEXITY 83 86 54.744445 $2794.7100 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.066667 $3.4100 $51.0700
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 190 199 98.815075 $5044.4900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 36 37 24.683334 $1260.0900 $51.0500
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Subtotal (Total Children Is Unduplicated) 375 529 303.372220 $16059.7200 $52.9400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 2.000000 $10000.0000 $5000.0000
AUDE -V5160 DISPENSING FEE BINAURAL 4 4 1.427777 $328.3700 $229.9900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 1 0.833333 $41.6700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 112 121 71.519046 $3575.9500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 20 20 11.914286 $595.7200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 353 373 239.896821 $11994.8200 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 63 64 413.428569 $10335.7300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 542 581 3688.734944 $184436.8000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 604 1178 4459.800023 $44598.0000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 121 126 580.892859 $41499.0000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 6 6 39.204762 $2242.5100 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 97 101 503.535719 $35972.5900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 14 14 128.857142 $7365.4800 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 150 158 887.607942 $63410.7100 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 4.428571 $253.3200 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 0.357143 $4.9600 $13.8800
TRAV -TRAVS Travel by mile 34 45 23496.730164 $10456.0500 $0.4500
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Subtotal (Total Children Is Unduplicated) 766 2795 34531.169101 $427111.6300 $12.3700
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Total 3334 34841.702434 $443266.3200 $12.7200
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Number of Children (Unduplicated) With at Least One Authorization 805