Summary Report for FSPSAs Initiated During the Report Period Center: 04
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: 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 2568 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 11 13 4.288888 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 11 13 4.288888 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 4 4 1.016666 $49.3100 $48.5000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 2 2.214285 $99.6400 $45.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 0.150000 $7.6600 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 138 140 36.038897 $1839.8300 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.150000 $7.6600 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 108 110 39.930154 $2038.4100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 81 82 21.116668 $1078.0100 $51.0500
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Subtotal (Total Children Is Unduplicated) 272 340 100.616670 $5120.5100 $50.8900
EI Services, Class # 03
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 3 1.022222 $51.1100 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 3 3.000000 $150.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 35 90 24.488891 $1224.4600 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 15 15 10.044443 $502.2200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 8 8 4.488889 $224.4500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 7 7 9.022222 $451.1100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 6 7 5.677777 $283.8900 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 106 114 707.857145 $17696.4200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 689 716 5526.929381 $276346.3300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 685 755 5850.786526 $58507.8300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 191 201 1186.642858 $84773.6800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 0.428571 $24.5200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 147 152 861.271430 $61529.1500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 2.857143 $163.3100 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 2 3 1.344444 $306.5200 $227.9900
SENS -V5060 BEHIND EAR HEARING AID
1 1 1.000000 $228.0000 $228.0000
SENS -V5264 EARMOLD 3 4 1.755555 $31.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 131 134 718.857143 $51355.1100 $71.4400
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Subtotal (Total Children Is Unduplicated) 906 2215 14917.474640 $553849.6900 $37.1300
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Total 2568 15022.380198 $558970.2000 $37.2100
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Number of Children (Unduplicated) With at Least One Authorization 916