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 3555 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 12 12 38.622224 $1429.0300 $37.0000
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Subtotal (Total Children Is Unduplicated) 24 26 85.112700 $1429.0300 $16.7900
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 13 14 12.983334 $629.6900 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 12 12 9.938890 $235.5500 $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) 1 1 1.000000 $16.7000 $16.7000
EXIT -EXIT EXIT ASSESSMENT 5 5 6.866667 $343.3400 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 16 17 17.955556 $1346.6700 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 24 24 27.150000 $2036.2500 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 10 10 8.799999 $659.9900 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 18 18 18.755556 $1040.9400 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 3.500000 $194.2500 $55.5000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 3.550000 $177.5000 $50.0000
SCREEN-T1023 SCREENING 2 2 11.947619 $597.3800 $50.0000
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Subtotal (Total Children Is Unduplicated) 76 111 126.303177 $7592.2400 $60.1100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 3.055556 $15278.0000 $5000.0700
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 1.933333 $96.6700 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 6.066667 $303.3400 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 11 13 12.522222 $2880.1100 $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 103 133 337.382541 $16869.1400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.533333 $13.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 94 115 203.797618 $10189.8800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 6.422222 $160.5600 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 6 10 20.277777 $1486.7600 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 1 25.714286 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 15 17 82.134917 $2053.3800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 110 134 1533.726190 $76686.3300 $50.0000
INTR -T1013 INTERPRETER 2 2 26.333334 $1316.6700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1201 2528 22575.464286 $225754.6200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 8 9 55.569841 $3969.9200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 19.857143 $1135.8300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 5 6 39.328572 $2809.6400 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 2 1.205555 $78.3600 $65.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 12 16 205.776191 $14700.6600 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 4.571429 $63.4500 $13.8800
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Subtotal (Total Children Is Unduplicated) 1211 3418 26014.288889 $418406.5800 $16.0800
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Total 3555 26225.704766 $427427.8500 $16.3000
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Number of Children (Unduplicated) With at Least One Authorization 1219