Summary Report for FSPSAs Ending During the Report Period Center: 53
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: 01-01-19 and 03-31-19 Date of Report: 05-04-19 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 951 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 2 2 1.200000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 2 1.200000 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 4 4 4.000000 $194.0000 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 0.422222 $10.0100 $23.7000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 1.000000 $84.8400 $84.8400
EXIT -EXIT EXIT ASSESSMENT 1 1 0.288889 $14.4500 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 5 5 3.766667 $282.5000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 10 10 5.972223 $447.9200 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 5 5 2.655556 $199.1700 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 10 10 6.350000 $352.4200 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 3.500000 $194.2500 $55.5000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.000000 $50.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 27 41 28.955557 $1829.5600 $63.1900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 2.800000 $140.0000 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 4 4 3.127778 $719.3900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 24 24 21.922222 $1096.1100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.000000 $25.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 50 60 60.633336 $3031.6800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 31 35 35.597620 $1779.8900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.911111 $22.7800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 38 39 65.304762 $3265.2400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 29 31 28.808729 $1440.4300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.333333 $8.3300 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 1.000000 $73.3200 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 1 6.000000 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 6 6 10.277778 $256.9500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 34 36 170.526191 $8526.3000 $50.0000
INTR -T1013 INTERPRETER 1 1 3.200000 $160.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 446 662 2358.181726 $23581.8100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 14.571428 $1040.9900 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 0.066667 $4.7700 $71.4700
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Subtotal (Total Children Is Unduplicated) 449 908 2785.262681 $50172.9700 $18.0100
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Total 951 2815.418238 $52002.5300 $18.4700
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Number of Children (Unduplicated) With at Least One Authorization 451