Summary Report for FSPSAs Ending During the Report Period Center: 53
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: 07-01-17 and 06-30-18 Date of Report: 08-10-18 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 6322 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 5 5 2.677777 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 6 7 48.385714 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 11 12 51.063491 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 6 8 7.438890 $360.7900 $48.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.677778 $14.4700 $21.3500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 117 125 231.788893 $4995.0600 $21.5500
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 8 6.594445 $296.7500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 6 8 7.372222 $847.8000 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 0.005556 $0.2800 $50.4000
EXIT -EXIT EXIT ASSESSMENT 16 16 16.499999 $825.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 3 2.822222 $211.6700 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 48 75 102.253172 $7668.9700 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 72 137 128.883338 $9666.2900 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 4 6 4.844444 $363.3300 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 41 64 70.244447 $5268.3500 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 91 157 163.638892 $9081.9800 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 15 16 29.883334 $2241.2600 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 88 89 400.500000 $22227.7500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 65 68 136.000000 $10200.0000 $75.0000
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 0.294444 $15.0300 $51.0400
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.172222 $2.5800 $15.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.011111 $51.6200 $51.0500
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Subtotal (Total Children Is Unduplicated) 326 786 1312.925409 $74488.9700 $56.7400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 14 21 15.427778 $77139.0000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.172222 $8.6100 $49.9900
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 5 6 23.952381 $1197.6200 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.616667 $44.1600 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 63 71 51.127780 $11759.4400 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 130 151 211.378571 $10568.9400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 11 11 8.655556 $216.3900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 397 684 1463.194868 $73159.8400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 18 19 35.039682 $875.9900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 12 13 21.611110 $1080.5500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 15 15 32.930159 $1646.5200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 2 6.466667 $161.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 10 10 19.055556 $952.7800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 2.100000 $52.5000 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 25 29 125.276190 $9185.2400 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 36 41 337.711107 $8442.7700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1066 1768 19908.560297 $995427.9400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1131 2595 21993.623809 $219936.2400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 26 32 407.404762 $29105.0100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 6 6 43.657142 $2497.1800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 5 5 38.792064 $2771.3100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 6.733333 $384.8800 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 2 1.900000 $123.5000 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 1.694444 $386.3200 $227.9900
SENS -V5060 BEHIND EAR HEARING AID 2 2 0.477778 $108.9400 $228.0100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 3 5 4.977778 $2269.8800 $456.0000
SENS -V5264 EARMOLD 6 9 11.066666 $199.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 15 17 156.228571 $11160.9800 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 13.214286 $755.8600 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 30.466667 $422.8800 $13.8800
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Subtotal (Total Children Is Unduplicated) 1140 5524 44973.513891 $1462042.1200 $32.5100
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Total 6322 46337.502791 $1536531.0800 $33.1600
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Number of Children (Unduplicated) With at Least One Authorization 1154