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 06-30-20 Date of Report: 07-20-20 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 4809 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 24 24 31.233333 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 12.333333 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 2 2 15.480953 $572.8000 $37.0000
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Subtotal (Total Children Is Unduplicated) 27 27 59.047619 $572.8000 $9.7000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 11 11 8.792999 $426.4600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $56.4900 $56.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 8 8 5.566667 $77.2100 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 72 79 66.250000 $1570.1200 $23.7000
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 4 2.466666 $111.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.838889 $96.4700 $115.0000
EXIT -EXIT EXIT ASSESSMENT 8 8 13.594444 $679.7200 $50.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 1.000000 $75.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 1.500000 $112.5000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 3.133333 $173.9000 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 3 18.399999 $920.0000 $50.0000
SCREEN-T1023 SCREENING 5 6 31.369049 $1568.4600 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.555556 $79.4100 $51.0500
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Subtotal (Total Children Is Unduplicated) 114 127 159.467602 $6168.7400 $38.6800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 8 8 8.366667 $41833.5000 $5000.0200
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 1.088889 $54.4500 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 6 6 5.772222 $413.3500 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 23 23 19.911111 $4579.5500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 63 73 64.402381 $3220.1200 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 2 3 2.005556 $100.2800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 6 4.500000 $112.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 45 51 154.753176 $7737.6700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 9.857143 $246.4300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 134 167 392.002381 $19600.1200 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 15 15 27.638888 $1381.9400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 8 8 41.881746 $1047.0500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 82 97 237.799203 $11889.9400 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 10 10 10.622222 $531.1100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.500000 $12.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 108 127 248.293653 $12414.6900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 24 25 21.616666 $1080.8300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 9.777777 $244.4400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 56 116 575.626983 $14390.6900 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 8 8 43.740476 $2187.0300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 803 1188 13454.311896 $672715.7100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 122 125 695.433332 $34771.6900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1032 2023 20335.597092 $203356.0100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 104 156 1769.530948 $126415.3200 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 12 12 81.942856 $5853.9900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 11 11 156.066667 $8927.0200 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 2 2 34.857143 $1993.8300 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 2 2 23.714286 $1694.1500 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 10 10 59.414286 $4244.5600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 97 137 1800.135712 $128601.7300 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 12 12 100.033334 $7146.3900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 6 6 76.733333 $4386.0700 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 6.866667 $392.5000 $57.1600
PHY -97110TLGT PT SESSION BY LICENSED PT 14 15 55.838095 $3989.0800 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 2.000000 $456.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.076712 $34.9800 $455.9300
SENS -V5264 EARMOLD 2 2 2.153425 $38.7600 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 109 153 1615.760322 $115429.9000 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 21 21 105.023809 $7502.8900 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 21 22 102.864285 $7348.6300 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 36.190476 $502.3200 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 2.285714 $31.7300 $13.8800
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Subtotal (Total Children Is Unduplicated) 1171 4655 42396.987530 $1458911.4100 $34.4100
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Total 4809 42615.502751 $1465652.9500 $34.3900
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Number of Children (Unduplicated) With at Least One Authorization 1188