Summary Report for FSPSAs Ending During the Report Period Center: 06
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: 07-01-19 and 09-30-19 Date of Report: 11-04-19 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2807 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 72 73 91.323808 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 72 73 91.323808 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 60 62 132.571429 $6628.5700 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 2.000000 $102.1000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 2.000000 $102.1000 $51.0500
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Subtotal (Total Children Is Unduplicated) 62 64 136.571429 $6832.7700 $50.0300
EI Services, Class # 03
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 2.655556 $132.7800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 15 17 19.177781 $958.9100 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 5 5 5.000000 $1150.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 181 190 47.298935 $2365.1400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 9 9 1.525002 $38.1300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 18 18 26.566669 $1328.3500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 11 13 12.700002 $317.5100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 6 6 8.766667 $438.3400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 7 8 6.550001 $163.7500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 3 3 3.450000 $172.5000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 2.666667 $66.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 11 11 15.908336 $795.4300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 9 9 9.166667 $229.1700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 77 95 1169.428571 $29235.7300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 675 754 4354.442843 $217722.2300 $50.0000
INTR -T1013 INTERPRETER 25 28 69.942857 $3497.1500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 844 1041 5853.378560 $58533.8100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 92 106 310.615476 $22190.3900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 25 26 84.503572 $4833.6000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 77 85 289.707148 $20696.6500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 1.285714 $73.4900 $57.1600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 6 6 7.600000 $3465.6000 $456.0000
SENS -V5264 EARMOLD 13 15 18.877780 $339.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 190 210 755.385718 $53964.7700 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 10 10 18.642859 $258.7600 $13.8800
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Subtotal (Total Children Is Unduplicated) 1005 2670 13095.243381 $422968.6300 $32.3000
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Total 2807 13323.138618 $429801.4000 $32.2600
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Number of Children (Unduplicated) With at Least One Authorization 1066