Summary Report for FSPSAs Ending During the Report Period Center: 52
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: 01/01/09 and 03/31/09 Date of Report: 05-18-09 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
Screening, Eval, and Assessment, Class # 02
AUDE -AUDE UNSPECIFIED AUDE SERVICES 1 1 1.00 $60.00 $60.00
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 3 4 6.00 $750.00 $125.00
EVAL -EVAL DEVELOPMENTAL EVALUATION 1 1 1.00 $50.00 $50.00
EXIT -EXIT TRANSITION ASSESSMENT 10 12 12.00 $600.00 $50.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 1 1 1.00 $48.50 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 63 73 73.00 $3540.50 $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 24 28 28.00 $1358.00 $48.50
SCREEN-T1023 INTERDISCIPLINARY SCREENING 5 5 5.00 $250.00 $50.00
SPCH -92506 SPEECH EVAL BY LICENSED SLP 91 98 98.23 $4764.32 $48.50
VISF -VISF VISION EVALUATION FUNCTIONAL 2 2 2.00 $100.00 $50.00
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Subtotal (Total Children Is Unduplicated) 166 226 228.23 $11569.82 $50.69
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 3.00 $4500.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 3 3 7.00 $350.00 $50.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 61 71 96.75 $4837.26 $50.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 34 36 33.50 $1675.00 $50.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 30 32 34.30 $1714.99 $50.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 69 78 97.92 $4895.84 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.97 $24.17 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 142 169 717.54 $35876.97 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 2 2 16.00 $800.00 $50.00
INTR -INTR INTERPRETER 1 3 6.00 $300.00 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 67 70 435.17 $29539.59 $67.88
OCCT -97530HM OT SESSION BY OT ASST 1 1 5.57 $302.64 $54.32
PHY -97110 PT SESSION BY LICENSED PT 91 98 422.61 $28686.82 $67.88
SCONLY-SCONLY SERVICE COORDINATION ONLY 5 5 3.82 $3.82 $1.00
SENS -V5264 EARMOLD 1 1 3.60 $67.39 $18.72
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 2 2 10.29 $514.29 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 236 270 1149.01 $77994.92 $67.88
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 3.07 $40.54 $13.20
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 301 468 175795.98 $87897.99 $0.50
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 8 8 23.28 $1163.81 $50.00
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Subtotal (Total Children Is Unduplicated) 390 1323 178865.37 $281186.02 $1.57
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Total 1549 179093.60 $292755.84 $1.63
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Number of Children (Unduplicated) With at Least One Authorization 429