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: 07-01-19 and 09-30-19 Date of Report: 11-04-19 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 937 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 4 4 1.577777 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 2.733333 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 5 4.311110 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 2 2 0.200608 $9.7300 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 4 3.388889 $80.3200 $23.7000
EXIT -EXIT EXIT ASSESSMENT 1 1 0.750000 $37.5000 $50.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 3 4.299999 $215.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 10 11 10.639496 $453.5400 $42.6300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 3.200000 $16000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.188889 $9.4500 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $230.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 22 26 25.561111 $1278.0600 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 22 23 24.882540 $1244.1300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 54 56 59.827779 $2991.4000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.857143 $21.4300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 43 44 45.261113 $2263.0700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 25 25 28.073809 $1403.6900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 2.666667 $66.6700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 7 10 17.388890 $434.7300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 27 28 143.447622 $7172.3800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 478 682 2261.504951 $22615.0500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 4 18.961906 $1354.6500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 8 8 18.466666 $1319.2500 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 7 7 28.349207 $2025.2700 $71.4400
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Subtotal (Total Children Is Unduplicated) 481 921 2679.638293 $60429.1800 $22.5500
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Total 937 2694.588899 $60882.7200 $22.5900
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Number of Children (Unduplicated) With at Least One Authorization 487