Summary Report for FSPSAs Ending During the Report Period Center: 54
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 2533 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 10.166666 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 6.228571 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 6 6 16.395237 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 43 53 41.122222 $1994.4300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 4 4 2.705556 $152.8400 $56.4900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 9 9 5.194445 $123.1100 $23.7000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 6 7 6.894445 $584.9300 $84.8400
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 3 3 0.177778 $3.9800 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 5 2.616666 $117.7500 $45.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 0.041667 $2.0900 $50.0400
EXIT -EXIT EXIT ASSESSMENT 60 61 109.804904 $5490.2400 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 0.183333 $13.7500 $74.9900
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 3 4.183333 $313.7500 $75.0000
SCREEN-T1023 SCREENING 7 7 4.077776 $203.8800 $50.0000
VISD -99204 VISION EVAL DIAG (MOD COMPLEXITY) 2 2 1.044445 $79.0900 $75.7200
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Subtotal (Total Children Is Unduplicated) 128 156 178.046570 $9079.8200 $51.0000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 31 49 56.103653 $280518.5000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.120548 $6.0300 $49.9800
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 3 0.900000 $64.4500 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 1.000000 $230.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 106 116 101.670223 $5083.5200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 3 1.172223 $29.3100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 96 118 150.864289 $7543.2400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 101 106 88.188889 $4409.4500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 54 58 71.426986 $3571.3600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 131 136 96.705553 $4835.2700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.544444 $13.6100 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 5 5 39.122222 $2868.4400 $73.3200
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 422 471 2246.438081 $112321.9600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 598 1091 3543.571413 $35435.7200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 54 55 262.364287 $18743.3000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 4 4 9.361111 $535.4600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 65 70 309.718254 $22126.2800 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 3 18.711110 $1069.5200 $57.1600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 2 0.588889 $268.5400 $456.0100
SENS -V5264 EARMOLD 2 2 0.655556 $11.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 62 71 325.551981 $23257.4200 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 2.638889 $150.9500 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 5.733333 $79.5800 $13.8800
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Subtotal (Total Children Is Unduplicated) 611 2371 7333.151934 $523173.6700 $71.3400
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Total 2533 7527.593741 $532253.5000 $70.7100
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Number of Children (Unduplicated) With at Least One Authorization 617