Summary Report for FSPSAs Initiated During the Report Period Center: 02
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 2857 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 3 3 5.133333 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 3 3 5.133333 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 28 30 13.949164 $676.5400 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.294444 $6.9800 $23.7000
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 0.022222 $1.1100 $49.9500
EXIT -EXIT EXIT ASSESSMENT 76 77 77.084933 $3854.2500 $50.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 14 14 20.021916 $1501.6500 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 13 13 24.005479 $1800.4100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 37 37 55.549311 $3083.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 31 31 57.510958 $4313.3300 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.227397 $11.6100 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 2 2 11.019842 $562.5700 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 2 2 1.383333 $70.6200 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 5 5 13.100588 $668.7900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 4 4 2.538888 $129.6100 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 2.000000 $102.1000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 2.068494 $105.5900 $51.0500
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Subtotal (Total Children Is Unduplicated) 169 224 282.776969 $16999.1300 $60.1100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 7 6.144444 $30722.0000 $4999.9600
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.049315 $3.5300 $71.5900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 68 72 63.021921 $3151.1000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 3 1.538851 $38.4700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 278 302 523.663637 $26183.1900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 4.933334 $123.3400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 141 143 238.114284 $11905.7100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 5.300000 $132.5000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 23 23 45.366668 $2268.3400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 220 222 395.997619 $19799.8800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 3.166667 $79.1700 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 9.714286 $712.2500 $73.3200
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 60 63 424.914295 $21245.7000 $50.0000
INTR -T1013 INTERPRETER 22 33 83.826615 $4191.3300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 347 606 2760.765818 $27607.6200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 9 9 78.107144 $5579.9600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 10 10 80.850001 $5775.9100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 9.571429 $547.1000 $57.1600
SENS -V5264 EARMOLD 1 1 0.002740 $0.0500 $17.7400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 8 8 56.285715 $4021.0500 $71.4400
TRAV -TRAVS Travel by mile 430 1118 218793.610698 $97363.1600 $0.4500
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Subtotal (Total Children Is Unduplicated) 443 2630 223584.945481 $261451.3400 $1.1700
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Total 2857 223872.855783 $278450.4700 $1.2400
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Number of Children (Unduplicated) With at Least One Authorization 479