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 3883 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 -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 5 5 3.655556 $78.7800 $21.5500
EXIT -EXIT EXIT ASSESSMENT 16 16 16.499999 $825.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 2 1.033333 $77.5000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 27 27 15.811112 $1185.8400 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 57 59 32.694449 $2452.1200 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 4 4 2.244444 $168.3300 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 30 30 21.500003 $1612.5200 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 64 66 43.733337 $2427.2200 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 0.627778 $47.0900 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 6 6 11.000000 $610.5000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 3 3 6.000000 $450.0000 $75.0000
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Subtotal (Total Children Is Unduplicated) 122 227 162.238901 $10295.6800 $63.4600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 7 5.188889 $25944.5000 $5000.0100
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 3 3.611111 $180.5600 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 4 4 2.588890 $595.4700 $230.0100
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 396 680 1449.861534 $72493.1700 $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 6 7 38.033333 $2788.6000 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 9 12 34.525396 $863.1400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 88 109 989.954758 $49497.7600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1131 2595 21993.623809 $219936.2400 $10.0000
PHY -97110 PT SESSION BY LICENSED PT 1 1 0.877778 $62.7100 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 2 1.900000 $123.5000 $65.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 2 7.066667 $504.8500 $71.4400
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Subtotal (Total Children Is Unduplicated) 1133 3644 24864.469466 $388545.8100 $15.6300
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Total 3883 25077.771858 $398841.4800 $15.9000
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Number of Children (Unduplicated) With at Least One Authorization 1144