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 1902 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 42 52 40.122222 $1945.9300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.427778 $24.1700 $56.4900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.194444 $4.6100 $23.6900
AUDE -92585 AUD EVOKED RESPONSE (COMP) 2 2 1.166667 $98.9800 $84.8400
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.044444 $0.9900 $22.3800
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.022222 $1.0000 $44.9600
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 0.041667 $2.0900 $50.0400
EXIT -EXIT EXIT ASSESSMENT 58 59 106.804904 $5340.2400 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 0.183333 $13.7500 $74.9900
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Subtotal (Total Children Is Unduplicated) 101 119 149.007681 $7431.7500 $49.8700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 18 28 34.927779 $174639.5000 $5000.0200
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.120548 $6.0300 $49.9800
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.044444 $10.2100 $229.7700
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 100 105 84.722222 $4236.1100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 53 57 67.426986 $3371.3600 $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 3 3 20.860318 $1529.4800 $73.3200
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 72 77 386.139682 $19306.9900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 598 1090 3538.571413 $35385.7200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 6 6 23.630158 $1688.1300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 1.777778 $101.6900 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 10 11 35.751588 $2554.1000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 0.933333 $53.3500 $57.1600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.022222 $10.1200 $455.5500
SENS -V5264 EARMOLD 1 1 0.088889 $1.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 19 19 91.207935 $6515.8900 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 2.533333 $144.9000 $57.2000
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Subtotal (Total Children Is Unduplicated) 606 1777 4639.715360 $267060.1100 $57.5600
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Total 1902 4805.118278 $274491.8600 $57.1200
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Number of Children (Unduplicated) With at Least One Authorization 612