Summary Report for FSPSAs Initiated During the Report Period Center: 53
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 836 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
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 3.200000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 2 3.200000 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 1.000000 $48.5000 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.233333 $5.5300 $23.7000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 2 2 1.211111 $102.7500 $84.8400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 1.000000 $16.7000 $16.7000
EXIT -EXIT EXIT ASSESSMENT 3 3 4.577778 $228.8900 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 0.544444 $40.8300 $74.9900
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 3 3 0.633333 $47.5000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 4 4 1.672222 $125.4200 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 4 4 2.088889 $115.9300 $55.5000
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Subtotal (Total Children Is Unduplicated) 14 21 12.961110 $732.0500 $56.4800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.055556 $278.0000 $5003.9600
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 22 23 21.672222 $1083.6100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 0.500000 $12.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 50 62 72.644446 $3632.2300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 18 18 15.033334 $751.6700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.422222 $10.5600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 23 24 22.044442 $1102.2100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 28 29 20.027778 $1001.3900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.166667 $29.1700 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 2 2 3.633333 $266.3900 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 3 3 7.952382 $198.8100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 42 44 265.092860 $13254.6600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 462 600 2591.594477 $25915.9400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 0.455556 $32.5500 $71.4500
OCCT -97530HM OT SESSION BY OT ASST 1 1 1.571429 $89.8800 $57.2000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.200000 $13.0000 $65.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 0.142857 $10.2100 $71.4600
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Subtotal (Total Children Is Unduplicated) 468 813 3024.209561 $47682.7700 $15.7700
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Total 836 3040.370671 $48414.8200 $15.9200
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Number of Children (Unduplicated) With at Least One Authorization 470