Summary Report for FSPSAs Initiated During the Report Period Center: 02
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: 10-01-20 and 12-31-20 Date of Report: 01-23-21 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 1448 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
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 26 28 27.595097 $1338.3600 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $13.8700 $13.8700
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.000000 $45.0000 $45.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 1 1 1.000000 $50.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 38 38 40.687671 $2034.3800 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 5 5 10.500000 $787.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 3 3 6.000000 $450.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 21 21 45.000000 $2497.5000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 8 8 18.500000 $1387.5000 $75.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 2 2 0.320548 $16.3600 $51.0400
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 7 7 3.579300 $182.7200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.466667 $23.8300 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.5500 $44.5500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 91 121 162.649283 $9195.6700 $56.5400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 8 10 8.180822 $40904.0000 $4999.9900
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.000000 $71.6100 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $230.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 74 82 75.126754 $3756.3300 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 3 3 2.406944 $120.3500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 4 2.012500 $50.3100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 167 181 309.431313 $15471.5700 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 1.466667 $73.3400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 92 93 160.185715 $8009.2900 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 3 3 6.885714 $344.2900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 1.800000 $45.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 17 17 18.200000 $910.0000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.300000 $7.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 153 156 259.971427 $12998.5700 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 2 2 2.366667 $118.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.400000 $35.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 46 51 292.228566 $14611.4500 $50.0000
INTR -T1013 INTERPRETER 12 22 77.587865 $3879.4000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 191 346 1574.886416 $15748.8800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 8 8 65.000000 $4643.5900 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 6 6 44.857143 $3204.5900 $71.4400
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.000000 $456.0000 $456.0000
SENS -V5264 EARMOLD 1 1 2.000000 $36.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 10 10 66.571429 $4755.8500 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 1.428571 $19.8300 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 1.000000 $37.0000 $37.0000
TRAV -TRAVS Travel by mile 164 322 78413.051808 $34893.8100 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 240 1327 81391.346321 $165431.8800 $2.0300
-------------------------------------------------------------------------------------------------------------------------------------
Total 1448 81553.995604 $174627.5500 $2.1400
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 279