Summary Report for FSPSAs Ending During the Report Period Center: 01
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: 10-01-18 and 12-31-18 Date of Report: 02-05-19 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 4542 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 79 81 118.286510 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.788889 $29.1900 $37.0000
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Subtotal (Total Children Is Unduplicated) 80 82 119.075399 $29.1900 $0.2500
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 19 20 14.322756 $694.6600 $48.5000
EXIT -EXIT EXIT ASSESSMENT 202 206 409.500000 $20475.0000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 1.500000 $112.5000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 1.500000 $112.5000 $75.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 10 10 19.000000 $1425.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 21 21 36.500000 $2025.7500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 18 20 32.500000 $2437.5000 $75.0000
OCTH -97167 OT EVAL HIGH COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 2.000000 $102.1000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 249 283 519.822756 $27538.1600 $52.9800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 9 9 14.223288 $71116.5000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 12 12 6.394445 $319.7300 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.044444 $10.2100 $229.7700
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 231 255 266.039571 $13301.9900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 4 5 4.500000 $112.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 114 125 215.153177 $10757.6700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 2.200000 $55.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 29 30 55.960318 $2798.0200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 4.900000 $122.5000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 56 58 84.134129 $4206.7100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.766667 $44.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 86 93 125.141252 $6257.0800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 4.833334 $120.8400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 64 69 365.685713 $18284.3000 $50.0000
INTR -T1013 INTERPRETER 141 148 382.251433 $19112.5900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1008 1511 6839.108277 $68391.0800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 10 12 75.142859 $5368.2000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 6 6 19.423809 $1387.6400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 3.714286 $212.3100 $57.1600
RSPT -RSPT RESPITE 1 1 3.571429 $0.0000 $0.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 31 32 210.252378 $15020.4600 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 7.571429 $105.0900 $13.8800
TRAV -TRAVS Travel by mile 1231 1802 7405.237208 $3295.3300 $0.4500
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Subtotal (Total Children Is Unduplicated) 1294 4177 16097.249446 $240399.9100 $14.9300
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Total 4542 16736.147601 $267967.2600 $16.0100
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Number of Children (Unduplicated) With at Least One Authorization 1363