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 3779 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 -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 6 6 4.527778 $97.5700 $21.5500
EXIT -EXIT EXIT ASSESSMENT 15 15 152.633333 $7631.6700 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 15 15 11.711111 $878.3300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 31 32 44.636510 $3347.7500 $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 17 17 10.477781 $785.8600 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 36 37 30.866668 $1713.1100 $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 6 168.000000 $9324.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 5 5 9.516667 $713.7500 $75.0000
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Subtotal (Total Children Is Unduplicated) 86 146 444.180960 $25106.5500 $56.5200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 8 6.788889 $33944.5000 $5000.0100
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 18.623810 $931.1900 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 2.550000 $586.5000 $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 340 596 1334.559137 $66728.0400 $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 4 5 9.311111 $682.6900 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 8 10 29.593651 $739.8400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 114 150 1261.296036 $63064.8300 $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
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 1.138889 $74.0300 $65.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 2 2.428571 $173.5000 $71.4400
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Subtotal (Total Children Is Unduplicated) 1181 3621 24705.975815 $397596.9000 $16.0900
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Total 3779 25183.701219 $422703.4500 $16.7800
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Number of Children (Unduplicated) With at Least One Authorization 1188