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 910 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 2 2 1.388889 $67.3600 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 0.766667 $18.1700 $23.7000
EXIT -EXIT EXIT ASSESSMENT 1 1 1.000000 $50.0000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 10 10 5.616668 $421.2600 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 12 12 5.077779 $380.8400 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.094444 $7.0800 $74.9700
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 7 7 6.500000 $487.5000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 11 11 9.305555 $516.4600 $55.5000
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Subtotal (Total Children Is Unduplicated) 28 46 29.750002 $1948.6700 $65.5000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.200000 $10.0000 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.066667 $76.3900 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 6 7 4.805555 $1105.2700 $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 26 27.234919 $1361.7500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 28 30 19.085713 $954.2800 $50.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 2 3 5.866667 $430.1500 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 1 6.571429 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 3 3 6.666666 $166.6700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 38 39 167.079368 $8353.9700 $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
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Subtotal (Total Children Is Unduplicated) 447 861 2580.328583 $48724.5700 $18.8800
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Total 910 2616.278585 $50673.2400 $19.3700
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Number of Children (Unduplicated) With at Least One Authorization 449