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: 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 6074 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 6 6 3.011110 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 4 6 30.533334 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 10 12 33.544444 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 9 10 10.238890 $496.5900 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 12 12 5.305556 $66.9000 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 83 92 173.033334 $3728.8700 $21.5500
AUDE -V5010 ASSESSMENT FOR HEARING AID 8 10 8.327778 $374.7500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 8 11 9.705555 $1116.1300 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 0.005556 $0.2800 $50.4000
EXIT -EXIT EXIT ASSESSMENT 15 15 152.633333 $7631.6700 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 33 48 64.549998 $4841.2400 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 46 80 157.453970 $11809.0700 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 0.944444 $70.8300 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 32 44 48.111116 $3608.3700 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 57 92 113.216668 $6283.5300 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 14 15 27.883334 $2091.2600 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 85 85 325.500000 $18065.2500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 67 70 139.516667 $10463.7500 $75.0000
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 0.294444 $15.0300 $51.0400
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) 282 589 1237.731754 $70715.1300 $57.1300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 19 23 18.905556 $94528.0000 $5000.0100
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 4 5 20.184921 $1009.2500 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.616667 $44.1600 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 48 53 45.377777 $10436.8700 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 121 142 137.971428 $6898.5800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 10 10 7.655556 $191.3900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 341 599 1346.425804 $67321.3700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 11 11 14.672222 $366.8100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 24 25 24.766666 $1238.3300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 18 20 38.680159 $1934.0200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 6.166667 $154.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 13 13 15.766667 $788.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 2.100000 $52.5000 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 24 26 82.230158 $6029.1100 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 31 35 257.573014 $6439.3300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1117 1799 19687.292862 $984364.6100 $50.0000
INTR -T1013 INTERPRETER 3 3 26.866666 $1343.3300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1168 2616 21764.161912 $217641.6300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 28 40 453.633333 $32407.5800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 6 6 48.352381 $2765.7500 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 3 3 16.477778 $1177.1700 $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 1.138889 $74.0300 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 1 2 1.544444 $352.1200 $227.9900
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.044444 $238.1200 $227.9900
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 5 7 11.722222 $5345.3200 $456.0000
SENS -V5264 EARMOLD 6 9 11.161110 $200.9000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 13 15 141.328570 $10096.5300 $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 40.971429 $568.6800 $13.8800
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Subtotal (Total Children Is Unduplicated) 1184 5473 44244.736921 $1455148.7200 $32.8900
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Total 6074 45516.013119 $1525863.8600 $33.5200
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Number of Children (Unduplicated) With at Least One Authorization 1194