Summary Report for FSPSAs Ending During the Report Period Center: 06
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: 02-06-19 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 1458 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 55 55 104.076191 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 55 55 104.076191 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 39 39 75.057534 $3752.8800 $50.0000
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Subtotal (Total Children Is Unduplicated) 39 39 75.057534 $3752.8800 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 169 181 20.631020 $1031.7900 $50.0100
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 9 9 1.394843 $34.8800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 20 22 21.259524 $1062.9800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 11 11 15.397620 $384.9400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 8 8 10.450000 $522.5000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 7 7 4.359524 $108.9900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 6 6 6.933333 $346.6700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.116667 $27.9200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 16 18 18.276190 $913.8100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 9 9 12.640477 $316.0200 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 24.571429 $614.2900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 42 45 254.999999 $12750.0100 $50.0000
INTR -T1013 INTERPRETER 21 22 81.999999 $4100.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 779 965 5739.219030 $57392.2000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 11 11 37.707142 $2693.8000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 14 15 65.071428 $4648.7000 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.024658 $1.6100 $65.1100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.000000 $456.0000 $456.0000
SENS -V5264 EARMOLD 2 2 0.977778 $17.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 27 28 102.571430 $7327.7000 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 24.285714 $337.0900 $13.8800
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Subtotal (Total Children Is Unduplicated) 807 1364 6444.887805 $95089.4700 $14.7500
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Total 1458 6624.021530 $98842.3400 $14.9200
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Number of Children (Unduplicated) With at Least One Authorization 859