Summary Report for FSPSAs Ending During the Report Period Center: 02
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: 01-01-18 and 03-31-18 Date of Report: 05-05-18 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 3320 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 1.300000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 1.300000 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 42 47 21.055359 $1021.1800 $48.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.200000 $4.2700 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 4 4 1.499011 $18.9000 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 0.350000 $7.5400 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 1.066667 $8.8100 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.066667 $27.0000 $25.3100
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 8.285714 $384.6200 $46.4200
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 1.066667 $22.0600 $20.6800
EXIT -EXIT EXIT ASSESSMENT 68 69 90.344750 $4517.2300 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 5 5 6.010958 $450.8300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 3 3 4.005479 $300.4100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 5 5 8.005479 $600.4100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 8 8 10.013698 $555.7600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 114 114 171.175331 $12838.1900 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 57 57 87.158899 $6536.9400 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 113 114 166.664370 $9249.9100 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 52 52 93.527395 $7014.5600 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 6 6 1.912938 $97.6600 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 9 11 1.451600 $74.1100 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 15 16 3.244368 $165.6300 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 5 5 0.610958 $31.1900 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 10 10 2.164460 $110.5000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 5 6 0.562558 $28.7200 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 18 18 2.415677 $123.3100 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 0.435084 $22.2100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 28 30 8.398329 $428.7400 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 14 14 3.507534 $179.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 337 603 696.199950 $44819.7400 $64.3800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 43 50 23.437018 $117183.5000 $4999.9300
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.066667 $53.3400 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 70 76 43.962548 $2198.0900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 1.255556 $31.3900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 223 268 368.471783 $18423.5700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.833333 $45.8300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 86 91 127.066667 $6353.3400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 30 31 45.966667 $2298.3400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 166 179 246.499996 $12324.9800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.833333 $45.8300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 9 10 301.428571 $7535.7100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 267 297 1595.198420 $79759.9100 $50.0000
INTR -T1013 INTERPRETER 28 42 76.738161 $3836.9100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 323 509 1775.345265 $17753.4400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 64 69 413.669045 $29552.5300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 14.000000 $800.8000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 72 74 388.350616 $27743.7900 $71.4400
SENS -V5264 EARMOLD 1 1 0.711111 $12.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 77 81 500.000001 $35719.9800 $71.4400
TRAV -TRAVS Travel by mile 478 931 144234.144305 $64184.2000 $0.4500
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Subtotal (Total Children Is Unduplicated) 520 2716 150160.979063 $425858.2500 $2.8400
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Total 3320 150858.479013 $470677.9900 $3.1200
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Number of Children (Unduplicated) With at Least One Authorization 533