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: 07-01-18 and 06-30-19 Date of Report: 07-21-19 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 6027 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 6 6 5.288888 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 7 10 74.957143 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 11 11 44.811113 $1658.0200 $37.0000
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Subtotal (Total Children Is Unduplicated) 23 27 125.057144 $1658.0200 $13.2600
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 19 21 20.611112 $999.6400 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 30 33 26.388892 $366.0200 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 72 78 67.583328 $1601.7100 $23.7000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.000000 $27.8300 $27.8300
AUDE -92585 AUD EVOKED RESPONSE (COMP) 3 3 3.466667 $294.1100 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 0.327778 $16.7400 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 2.366667 $39.5200 $16.7000
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 10 6.977777 $314.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 7 11 8.627778 $992.2000 $115.0000
EXIT -EXIT EXIT ASSESSMENT 6 6 46.866667 $2343.3400 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 34 54 64.977778 $4873.3400 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 54 88 113.734921 $8530.1200 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 23 36 46.622219 $3496.6400 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 35 60 91.088888 $5055.4300 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 6 6 8.500000 $637.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 20 20 242.500000 $13458.7500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 4 4 6.150000 $461.2500 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.000000 $50.0000 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 210 437 761.790472 $43759.1800 $57.4400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 28 32 30.866668 $154334.0000 $5000.0200
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 6 8 23.191270 $1159.5700 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 4 4 4.022223 $288.0400 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 49 56 64.966665 $14942.3000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 83 101 112.403968 $5620.2000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 1.500000 $37.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 254 366 768.966663 $38448.3200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 4 3.233333 $80.8300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 81 93 161.943652 $8097.1900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.333333 $33.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 81 97 247.426191 $12371.3200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.533333 $13.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 82 96 182.403173 $9120.1500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 4.144444 $103.6100 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 26 41 122.615079 $8990.1300 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 1 25.714286 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 39 48 205.409520 $5135.2500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1103 1758 19590.773767 $979538.7200 $50.0000
INTR -T1013 INTERPRETER 3 5 34.666667 $1733.3400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1172 2607 22902.233278 $229022.3400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 61 78 755.660312 $53984.3600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 10 10 69.900000 $3998.2700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 44 49 521.861901 $37281.8200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 39.000000 $2229.2400 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 2 1.716666 $111.5800 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 1 2 1.005556 $229.2800 $228.0100
SENS -V5060 BEHIND EAR HEARING AID 2 2 2.000000 $456.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 6 7 9.483334 $4324.4300 $456.0000
SENS -V5264 EARMOLD 8 11 16.244445 $292.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 59 70 728.390476 $52036.2100 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 4 5 19.504761 $270.7300 $13.8800
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Subtotal (Total Children Is Unduplicated) 1179 5563 46653.114964 $1624283.7500 $34.8200
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Total 6027 47539.962580 $1669700.9500 $35.1200
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Number of Children (Unduplicated) With at Least One Authorization 1185