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 849 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 -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.494444 $10.6500 $21.5500
EXIT -EXIT EXIT ASSESSMENT 6 6 3.772222 $188.6100 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 4 4 1.438889 $107.9200 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 7 7 15.114286 $1133.5700 $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 5 5 1.977778 $148.3400 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 8 8 5.350000 $296.9200 $55.5000
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Subtotal (Total Children Is Unduplicated) 20 33 29.736508 $1978.6800 $66.5400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 2.590476 $129.5200 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 26 26 17.981746 $899.0900 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 93 125 128.533331 $6426.6600 $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
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 2 2.677778 $66.9500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 29 33 102.923811 $5146.1900 $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
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Subtotal (Total Children Is Unduplicated) 444 812 2472.466678 $40344.8200 $16.3200
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Total 849 2513.855566 $42323.5000 $16.8400
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Number of Children (Unduplicated) With at Least One Authorization 449