Summary Report for FSPSAs Ending During the Report Period Center: 04
This report shows the total number of units/fees for FSPSAs ending during the report period.
(i.e., end 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 ending between: 07/01/08 and 09/30/08 Date of Report: 11-18-08 Page: 1
Eligibility Filter: Program Patients
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 19 21 22.00 $1067.00 $48.50
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.00 $36.07 $36.07
EVAL -EVAL DEVELOPMENTAL EVALUATION 83 89 87.36 $4367.78 $50.00
NUTR -NUTR UNSPECIFIED NUTRITIONAL EVAL 1 1 1.00 $50.00 $50.00
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 144 152 157.87 $7656.76 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 105 116 116.93 $5671.27 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 169 178 194.79 $9447.34 $48.50
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Subtotal (Total Children Is Unduplicated) 389 558 580.95 $28296.22 $48.71
EI Services, Class # 03
AUD -HA_FUP AUDIOLOGY SERVICES 15 15 15.00 $750.00 $50.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 294 319 529.92 $26496.09 $50.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 128 137 220.63 $11031.67 $50.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 78 81 134.01 $6700.72 $50.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 172 188 269.82 $13490.86 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.43 $35.83 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 122 152 619.00 $15474.95 $25.00
EIIF -T1024HN *EI INDIVIDUAL SESSION BY PROF 1 1 2.29 $114.29 $50.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 1 1 5.14 $128.57 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 456 547 3391.60 $169580.16 $50.00
INTR -INTR INTERPRETER 1 1 0.50 $25.00 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 196 233 846.30 $57446.55 $67.88
OCCT -97530HM OT SESSION BY OT ASST 1 1 2.43 $131.92 $54.32
PHY -97110 PT SESSION BY LICENSED PT 185 229 943.18 $64022.81 $67.88
SCONLY-SCONLY SERVICE COORDINATION ONLY 6 6 3.97 $3.97 $1.00
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 11 15 22.85 $1142.38 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 251 282 1037.52 $70426.80 $67.88
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 5.57 $73.54 $13.20
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 389 483 1413.43 $706.72 $0.50
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 13 16 71.67 $3583.58 $50.00
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Subtotal (Total Children Is Unduplicated) 732 2710 9536.26 $441366.39 $46.28
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Total 3268 10117.21 $469662.61 $46.42
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Number of Children (Unduplicated) With at Least One Authorization 762