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: 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 5793 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 8 8 6.619047 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 5 6 39.871429 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 54 54 192.308735 $7115.4400 $37.0000
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Subtotal (Total Children Is Unduplicated) 66 68 238.799211 $7115.4400 $29.8000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 17 19 17.838890 $865.1900 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 29 34 26.250004 $364.0900 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 74 80 69.044438 $1636.3400 $23.7000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 3 3 3.466667 $294.1100 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 0.388889 $19.8600 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 2.366667 $39.5200 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 24.857143 $556.8000 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 6 5.227777 $235.2500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 6 6.283333 $722.5800 $115.0000
EXIT -EXIT EXIT ASSESSMENT 5 5 6.866667 $343.3400 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 28 41 56.022223 $4201.6700 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 37 57 85.961113 $6447.1000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 16 27 37.405554 $2805.4100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 23 38 67.000001 $3718.5100 $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 19 19 32.500000 $1803.7500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 3.500000 $262.5000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 3.550000 $177.5000 $50.0000
SCREEN-T1023 SCREENING 4 4 17.180953 $859.0500 $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) 200 355 477.210319 $26191.1100 $54.8800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 24 30 27.716668 $138584.0000 $5000.0200
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 2.088889 $104.4500 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 5 5 30.066667 $1503.3400 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 3 3.066667 $219.6100 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 55 58 68.950000 $15858.5000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 85 103 120.265079 $6013.2500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 1.500000 $37.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 152 201 518.818255 $25940.9200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 96 111 210.699209 $10534.9700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.333333 $33.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 103 134 337.904763 $16895.2500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.533333 $13.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 95 117 205.408729 $10270.4300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 6.422222 $160.5600 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 26 39 125.859525 $9228.0300 $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 46 217.849198 $5446.2500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1066 1595 18211.565076 $910578.1200 $50.0000
INTR -T1013 INTERPRETER 2 2 26.333334 $1316.6700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1201 2530 22594.397619 $225943.9500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 95 116 1085.234120 $77529.1000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 10 10 49.795237 $2848.2800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 82 104 989.723810 $70705.8500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 4 50.704762 $2898.2800 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 2 1.205555 $78.3600 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 3 5.422223 $2472.5700 $456.0100
SENS -V5264 EARMOLD 5 7 10.855556 $195.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 105 129 1072.418260 $76613.5100 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 7 7 22.361905 $310.3800 $13.8800
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Subtotal (Total Children Is Unduplicated) 1217 5370 46026.214280 $1612790.1800 $35.0400
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Total 5793 46742.223810 $1646096.7300 $35.2200
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Number of Children (Unduplicated) With at Least One Authorization 1223