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 2852 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
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Subtotal (Total Children Is Unduplicated) 25 25 43.566666 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 8 8 6.481888 $314.3700 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 5 6 5.105555 $121.0000 $23.7000
EXIT -EXIT EXIT ASSESSMENT 7 7 11.594444 $579.7200 $50.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 3 18.399999 $920.0000 $50.0000
SCREEN-T1023 SCREENING 2 2 16.021429 $801.0700 $50.0000
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Subtotal (Total Children Is Unduplicated) 25 27 59.603315 $2847.1600 $47.7700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 3.777778 $18889.0000 $5000.0300
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 10 10 9.688889 $2228.4500 $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 108 126 245.493653 $12274.6900 $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 15 28 145.147620 $3628.7000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 8 8 43.740476 $2187.0300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 73 86 1044.895234 $52244.7800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 8 8 45.352380 $2267.6200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1031 2022 20325.168521 $203251.7300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 9 10 93.133332 $6653.4500 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 13.285714 $949.1300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 14 17 184.138096 $13154.8400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 17.857143 $1020.7100 $57.1600
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 1.857143 $132.6700 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 15 16 223.350794 $15956.1900 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 2.285714 $163.2900 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 4.571429 $326.5800 $71.4400
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Subtotal (Total Children Is Unduplicated) 1065 2800 23382.101055 $382583.7600 $16.3600
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Total 2852 23485.271036 $385430.9200 $16.4100
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Number of Children (Unduplicated) With at Least One Authorization 1081