Summary Report for FSPSAs Initiated During the Report Period Center: 01
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: 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 4323 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 50 50 65.130156 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 50 50 65.130156 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 25 27 21.001751 $1018.5800 $48.5000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 4.000000 $339.3600 $84.8400
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 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 256 288 526.501751 $27997.2400 $53.1800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 9 36.000000 $180000.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.855556 $42.7800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 7 7 3.016667 $150.8400 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 230 254 253.040061 $12652.0100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 6 7 9.733333 $243.3300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 103 114 231.214288 $11560.7200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 4 4.600000 $115.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 27 28 56.277781 $2813.9100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 2.366667 $59.1700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 53 55 95.455556 $4772.7800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 76 82 139.192065 $6959.6100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 6 6.366667 $159.1700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 31 32 195.985717 $9799.3000 $50.0000
INTR -T1013 INTERPRETER 133 147 407.065723 $20353.3000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1058 1458 7864.367088 $78643.6600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 5 5 41.571429 $2969.8700 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 4 4 26.571429 $1898.2700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 3.714286 $212.3100 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 14 14 146.571431 $10471.0600 $71.4400
TRAV -TRAVS Travel by mile 1126 1756 8398.905537 $3737.5200 $0.4500
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Subtotal (Total Children Is Unduplicated) 1163 3985 17922.871281 $347614.5800 $19.4000
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Total 4323 18514.503188 $375611.8200 $20.2900
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Number of Children (Unduplicated) With at Least One Authorization 1188