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: 07-01-18 and 09-30-18 Date of Report: 11-06-18 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 1412 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 1 1 1.000000 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 2 5.200000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 3 6.200000 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 3 3 2.388889 $115.8600 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 9 9 2.961112 $41.0700 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 16 16 9.616668 $227.9200 $23.7000
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 2.422222 $109.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 1.855555 $213.3800 $115.0000
EXIT -EXIT EXIT ASSESSMENT 1 1 1.000000 $50.0000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 16 25 20.105556 $1507.9200 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 16 28 21.511111 $1613.3300 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 2 0.283333 $21.2500 $74.9900
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 11 16 16.633334 $1247.5100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 13 23 27.983334 $1553.0800 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
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Subtotal (Total Children Is Unduplicated) 58 131 110.761114 $6961.3200 $62.8500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 6 4.055556 $20278.0000 $5000.0500
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 1.200000 $60.0000 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 3 1.833333 $131.2800 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 18 19 15.516666 $3568.8200 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 23 26 50.326985 $2516.3500 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 81 96 109.969840 $5498.4900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 37 37 26.535714 $1326.7900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 23 27 27.757141 $1387.8600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 28 30 19.085713 $954.2800 $50.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 12 14 30.503174 $2236.4900 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 1 6.571429 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 10 10 22.269841 $556.7400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 391 401 1906.447636 $95322.3000 $50.0000
INTR -T1013 INTERPRETER 2 2 9.633333 $481.6700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 431 588 2144.285727 $21442.8300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 8 8 24.538095 $1752.9900 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.433333 $197.5800 $455.9700
SENS -V5264 EARMOLD 2 2 1.433333 $25.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 2 13.266667 $947.7700 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 5.857143 $81.3000 $13.8800
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Subtotal (Total Children Is Unduplicated) 453 1278 4423.520659 $159223.3200 $35.9900
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Total 1412 4540.481773 $166184.6300 $36.6000
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Number of Children (Unduplicated) With at Least One Authorization 454