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 3757 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 3 3 7.627778 $282.2300 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 15 19 87.873809 $282.2300 $3.2100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 15 16 15.755556 $764.1500 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 6 6 4.661111 $110.4700 $23.7000
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) 1 1 1.000000 $16.7000 $16.7000
EXIT -EXIT EXIT ASSESSMENT 6 6 46.866667 $2343.3400 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 23 23 21.055555 $1579.1600 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 38 38 34.724602 $2604.3400 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 15 15 11.855554 $889.1600 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 29 29 28.249999 $1567.8700 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 3 3 213.500000 $11849.2500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 2.650000 $198.7500 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.000000 $50.0000 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 90 144 385.113489 $22284.0300 $57.8600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 7 6.055556 $30278.0000 $5000.0400
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 3 19.185714 $959.2900 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 11 14 13.283333 $3055.1600 $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 96 246.903969 $12345.2100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.533333 $13.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 81 94 180.792062 $9039.6000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 4.144444 $103.6100 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 7 11 21.777777 $1596.7400 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 1 25.714286 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 14 16 68.723807 $1718.1000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 117 152 1753.330951 $87666.5700 $50.0000
INTR -T1013 INTERPRETER 3 5 34.666667 $1733.3400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1172 2606 22890.633278 $228906.3400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 4 29.341270 $2096.1500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 19.857143 $1135.8300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 2 2 12.714286 $908.3100 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 2 1.716666 $111.5800 $65.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 6 8 121.666666 $8691.8800 $71.4400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1176 3594 26500.422157 $442676.3700 $16.7000
-------------------------------------------------------------------------------------------------------------------------------------
Total 3757 26973.409455 $465242.6200 $17.2500
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1183