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: 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 1412 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 3 3 1.366666 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 10.285714 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 4 4 11.652380 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 1.000000 $48.5000 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 4 4 1.761111 $22.2100 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 23 23 6.588889 $141.9900 $21.5500
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 4 2.233334 $100.5000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 5 1.333334 $153.3400 $115.0100
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 0.005556 $0.2800 $50.4000
EXIT -EXIT EXIT ASSESSMENT 6 6 3.772222 $188.6100 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 6 10 5.272223 $395.4200 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 9 16 46.298413 $3472.3900 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.588889 $44.1700 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 8 12 10.944444 $820.8300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 18 24 30.238888 $1678.2500 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 11 11 22.000000 $1221.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 10 10 20.000000 $1500.0000 $75.0000
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Subtotal (Total Children Is Unduplicated) 66 128 152.037303 $9787.4900 $64.3800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 5 5.000000 $25000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 3 2.879365 $143.9700 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 8 8 3.038890 $698.9700 $230.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 26 26 17.981746 $899.0900 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 95 127 135.466664 $6773.3200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.411111 $10.2800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3 3 0.672223 $33.6200 $50.0100
CONPF -CONPF CONSULT, PT, FACE TO FACE 3 3 0.216667 $10.8400 $50.0100
CONSF -CONSF CONSULT, SLP, FACE TO FACE 5 5 3.411111 $170.5600 $50.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 7 7 9.216667 $675.7700 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 2 2.677778 $66.9500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 401 457 1985.439696 $99271.9600 $50.0000
INTR -T1013 INTERPRETER 1 1 8.266667 $413.3400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 436 610 2203.781757 $22037.8100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 7 8 15.147617 $1082.1400 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.288889 $65.8700 $228.0100
SENS -V5060 BEHIND EAR HEARING AID
1 1 0.033333 $7.5900 $227.7700
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
4 4 4.377778 $1996.2800 $456.0000
SENS -V5264 EARMOLD 4 4 1.033334 $18.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 3 21.047618 $1503.6400 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 5.571429 $77.3300 $13.8800
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Subtotal (Total Children Is Unduplicated) 452 1280 4425.960340 $160957.8900 $36.3700
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Total 1412 4589.650023 $170745.3800 $37.2000
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Number of Children (Unduplicated) With at Least One Authorization 459