Summary Report for FSPSAs Initiated During the Report Period Center: 57
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: 01/01/08 and 12/31/08 Date of Report: 02-16-09 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
Service Coordination, Class # 01
IFSP -IFSP INDIVIDUALIZED FAMILY SUPPORT PLAN 59 70 38.48 $0.00 $0.00
SCTT -SCTT SERVICE COORDINATOR TRAVEL 38 46 33.00 $1221.00 $37.00
TCM -T1017TL TARGETED CASE MANAGEMENT 2 2 1.63 $60.23 $37.00
TCON -TCON TRANSITION CONFERENCE 4 4 4.00 $0.00 $0.00
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Subtotal (Total Children Is Unduplicated) 75 122 77.11 $1281.23 $16.62
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 0.32 $15.68 $48.50
AUD -92626 EVAL OF AUD REHAB STATUS 24 24 41.86 $1509.79 $36.07
AUDE -AUDE UNSPECIFIED AUDE SERVICES 48 48 120.78 $7246.66 $60.00
AUDE -V5090 DISPENSING FEE PER HEARING AID 25 27 28.02 $3351.46 $119.60
BEHV -90801 PSYCHIATRIC DIAG INTERVIEW 3 3 13.29 $1660.71 $125.00
BEHV -BEHV BEHAVIORAL ASSESSMENT 9 9 12.70 $1587.50 $125.00
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 36 37 71.84 $8979.46 $125.00
EVAL -EVAL DEVELOPMENTAL EVALUATION 1 1 1.00 $50.00 $50.00
FANE -FANE FAMILY INTERVIEW BY COMMUNITY PROVI 26 26 26.00 $780.00 $30.00
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 0.06 $4.58 $75.00
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.27 $20.42 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 6 6 6.50 $360.75 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 18 18 20.00 $1500.00 $75.00
MED -MED UNSPECIFIED MED OFFICE VISIT 1 1 1.00 $150.00 $150.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 2 2 2.00 $97.00 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 129 150 292.00 $14162.07 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 1 1 1.00 $48.50 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 173 200 199.30 $9665.88 $48.50
SCREEN-T1023 INTERDISCIPLINARY SCREENING 26 26 26.00 $1300.00 $50.00
SPCH -92506 SPEECH EVAL BY LICENSED SLP 539 667 812.48 $39405.10 $48.50
VISD -VISD VISION EVALUATION DIAGNOSTIC 1 1 5.47 $546.67 $100.00
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Subtotal (Total Children Is Unduplicated) 803 1250 1681.88 $92442.23 $54.96
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.00 $3000.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 37 37 37.00 $1850.00 $50.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 821 1033 3935.32 $196766.20 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 158 177 775.29 $19382.14 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 19 19 125.77 $6288.41 $50.00
CONOP -CONOP CONSULT, OT, PHONE 2 2 12.23 $305.83 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 18 20 99.90 $4995.01 $50.00
CONPP -CONPP CONSULT, PT, PHONE 4 5 19.70 $492.50 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 877 1117 4246.54 $212326.91 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 120 135 533.41 $13335.36 $25.00
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 30 31 320.33 $23518.75 $73.42
ECE -ECE EARLY CHILDHOOD EDUCATION 2 2 741.00 $9262.50 $12.50
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 23 27 459.14 $11478.58 $25.00
EIIF -90801 PSYCHIATRIC DIAG INTERVIEW 1 1 23.86 $1192.86 $50.00
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 2 2 30.14 $1507.14 $50.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 7 7 92.29 $2307.15 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1118 1531 24863.99 $1243199.32 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 133 156 1491.36 $101233.36 $67.88
OCCT -97530HM OT SESSION BY OT ASST 72 78 835.31 $45374.02 $54.32
PHY -97110 PT SESSION BY LICENSED PT 203 237 2526.87 $171524.11 $67.88
PHY -97110HM PT SESSION BY PT ASST 93 97 1278.36 $69440.38 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 2 2 2.00 $2.00 $1.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 1 1 2.00 $1000.00 $500.00
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 18 27 461.69 $23084.30 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 438 523 4055.36 $275278.04 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 6 6 81.29 $4415.44 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 144 163 1826.50 $24109.77 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 4 4 65.40 $6540.48 $100.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 1186 2079 48595.68 $24297.82 $0.50
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Subtotal (Total Children Is Unduplicated) 1495 7521 97539.72 $2497508.35 $25.61
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Total 8893 99298.71 $2591231.80 $26.10
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Number of Children (Unduplicated) With at Least One Authorization 1532