Summary Report for FSPSAs Initiated During the Report Period Center: 06
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: 02-06-19 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2510 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 56 56 100.215874 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 56 56 100.215874 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 1.000000 $48.5000 $48.5000
EXIT -EXIT EXIT ASSESSMENT 48 48 92.057534 $4602.8800 $50.0000
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Subtotal (Total Children Is Unduplicated) 49 49 93.057534 $4651.3800 $49.9800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 5 5 4.011111 $200.5600 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 13 13 12.288891 $614.4600 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 170 177 31.731918 $1586.8400 $50.0100
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 9 9 1.683732 $42.1000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 20 22 19.862700 $993.1400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 12 12 22.423809 $560.5900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 8 9 11.416666 $570.8300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 5 6 5.883333 $147.0800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 6 6 7.416667 $370.8400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 2.466666 $61.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 18 19 18.197620 $909.8800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 7 15.040476 $376.0100 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 42 42 1164.285711 $29107.1400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 605 657 4294.328634 $214716.4000 $50.0000
INTR -T1013 INTERPRETER 19 19 105.657143 $5282.8600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 793 968 6097.481041 $60974.8000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 87 94 382.717861 $27341.3600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 16 18 52.494049 $3002.6600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 79 93 369.409524 $26390.5800 $71.4400
SENS -V5060 BEHIND EAR HEARING AID 1 1 0.466667 $106.4100 $228.0200
SENS -V5264 EARMOLD 14 14 9.988890 $179.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 187 208 820.638094 $58626.2600 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 6.714286 $93.1900 $13.8800
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Subtotal (Total Children Is Unduplicated) 897 2405 13457.605489 $437255.4400 $32.4900
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Total 2510 13650.878897 $441906.8200 $32.3700
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Number of Children (Unduplicated) With at Least One Authorization 962