Summary Report for FSPSAs Initiated During the Report Period Center: 54
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
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1973 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 3 3 7.123810 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 5.333333 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 4 4 12.457143 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 30 35 27.022223 $1310.5800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 5 5 3.488660 $197.0700 $56.4900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.000000 $23.7000 $23.7000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 8 9 8.583334 $728.2200 $84.8400
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.633333 $14.1900 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 9 9 8.316667 $374.2500 $45.0000
EXIT -EXIT EXIT ASSESSMENT 49 50 85.655969 $4282.8100 $50.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 2 4.000000 $300.0000 $75.0000
SCREEN-T1023 SCREENING 7 7 2.944444 $147.2200 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.388889 $19.8500 $51.0500
VISD -99202 VISION EVAL DIAG (SIMPLE) 1 1 0.355556 $12.7900 $35.9800
VISD -99204 VISION EVAL DIAG (MOD COMPLEXITY) 1 1 0.866667 $65.6300 $75.7200
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.505556 $25.2800 $50.0000
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Subtotal (Total Children Is Unduplicated) 107 123 143.761298 $7501.5800 $52.1800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 21 31 36.429681 $182148.5000 $5000.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.077778 $5.5700 $71.6300
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 95 100 86.354120 $4317.7100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 1.005556 $25.1400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 60 67 82.560314 $4128.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 78 82 67.694442 $3384.7100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.200000 $5.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 63 69 55.405553 $2770.2700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 118 119 85.456348 $4272.8200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 3.061111 $76.5300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 340 364 1933.082558 $96654.0900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 470 855 2949.840488 $29498.3900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 53 57 321.648415 $22978.5600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 4.683334 $267.8900 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 44 47 203.842065 $14562.4800 $71.4400
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.316667 $144.4200 $456.0500
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 34 38 200.836505 $14347.7700 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 2 0.772223 $44.1800 $57.2100
SPL -92508 GROUP SPL SESSION PER CHILD 4 4 26.415873 $366.6500 $13.8800
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Subtotal (Total Children Is Unduplicated) 476 1846 6059.683031 $379998.6500 $62.7100
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Total 1973 6215.901472 $387500.2400 $62.3400
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Number of Children (Unduplicated) With at Least One Authorization 496