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: 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 2515 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 14 16 5.755553 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 14 16 5.755553 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 13 13 4.110198 $199.3400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 4.214286 $216.4000 $51.3500
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.928571 $41.7900 $45.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 3 3 0.294445 $15.0300 $51.0600
OCTH -97167 OT EVAL HIGH COMPLEXITY 152 168 46.827776 $2390.5500 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 2 0.561111 $28.6400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 106 110 25.633333 $1308.5800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 88 91 20.172223 $1029.8000 $51.0500
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Subtotal (Total Children Is Unduplicated) 267 389 102.741943 $5230.1300 $50.9100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.200000 $1000.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.144444 $7.2200 $49.9800
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 3 2.655556 $132.7800 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 20 50 10.911115 $545.5800 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 19 20 8.688892 $434.4600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 14 16 6.083335 $304.1800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 4 4 1.933334 $96.6700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 11 13 5.861112 $293.0600 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 80 93 533.857137 $13346.4500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 662 718 5171.775383 $258588.8000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 624 724 5138.027767 $51380.2800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 175 202 1052.071421 $75160.0000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 123 135 758.706342 $54201.9900 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.144444 $32.9200 $227.9300
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
1 1 0.655556 $298.9500 $456.0300
SENS -V5264 EARMOLD 1 2 0.800000 $14.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 116 125 628.642862 $44910.2300 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 1.000000 $57.2000 $57.2000
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Subtotal (Total Children Is Unduplicated) 838 2110 13322.158700 $500805.1600 $37.5900
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Total 2515 13430.656196 $506035.3000 $37.6800
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Number of Children (Unduplicated) With at Least One Authorization 848