Summary Report for FSPSAs Initiated During the Report Period Center: 01
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: 01-01-20 and 03-31-20 Date of Report: 05-15-20 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 5381 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
CASE -CASE NON-TCM CASE MANAGEMENT 1 1 0.833333 $30.8300 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 51 51 173.302378 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 6 6 151.638096 $5610.6100 $37.0000
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Subtotal (Total Children Is Unduplicated) 57 58 325.773807 $5641.4400 $17.3200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 24 26 21.637823 $1049.4300 $48.5000
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 2.000000 $76.9400 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 1.000000 $84.8400 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 1.000000 $51.0700 $51.0700
EXIT -EXIT EXIT ASSESSMENT 212 214 427.000000 $21350.0000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 4 6 10.000000 $750.0000 $75.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 12 12 21.500000 $1612.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 37 37 71.500000 $3968.2500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 31 34 62.000000 $4650.0000 $75.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 3 4 5.000000 $255.2500 $51.0500
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Subtotal (Total Children Is Unduplicated) 284 341 631.637823 $34499.3300 $54.6200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 3.216438 $16082.0000 $4999.9400
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 4.000000 $920.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 397 435 529.554972 $26477.7500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 45 47 55.527474 $1388.1900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 143 160 293.833329 $14691.6600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 3 5.600000 $140.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 51 53 79.322220 $3966.1000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.900000 $47.5000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 81 90 143.119841 $7156.0000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 3.566667 $89.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 108 118 206.330156 $10316.5000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 5 6.916667 $172.9200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 83 89 611.723809 $30586.2100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 1.714286 $85.7200 $50.0000
INTR -T1013 INTERPRETER 152 182 580.291268 $29014.5800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1175 1763 8576.776741 $85767.7500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 3 3 15.285714 $1092.0100 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 5 6 27.142857 $1939.0900 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 6 6 54.428571 $3888.3800 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 2.428571 $173.5000 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 18.142858 $251.8200 $13.8800
TRAV -TRAVS Travel by mile 1215 2005 8917.784243 $3968.4100 $0.4400
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Subtotal (Total Children Is Unduplicated) 1283 4982 20139.606682 $238265.2400 $11.8300
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Total 5381 21097.018312 $278406.0200 $13.2000
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Number of Children (Unduplicated) With at Least One Authorization 1307