Summary Report for FSPSAs Initiated During the Report Period Center: 52
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: 01/01/09 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 -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 1.00 $28.28 $28.28
AUDE -AUDE UNSPECIFIED AUDE SERVICES 5 5 5.00 $300.00 $60.00
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 5 6 8.00 $1000.00 $125.00
EXIT -EXIT TRANSITION ASSESSMENT 9 10 11.00 $550.00 $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 56 73 73.00 $3540.50 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 27 36 36.00 $1746.00 $48.50
SCREEN-T1023 INTERDISCIPLINARY SCREENING 12 12 12.00 $600.00 $50.00
SPCH -92506 SPEECH EVAL BY LICENSED SLP 102 113 113.00 $5480.50 $48.50
VISF -VISF VISION EVALUATION FUNCTIONAL 2 2 2.00 $100.00 $50.00
--------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 181 259 262.00 $13393.78 $51.12
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 4 5.00 $7500.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 4 4 4.00 $200.00 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 2 2 1.12 $55.84 $50.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 82 93 112.97 $5648.47 $50.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 40 43 57.36 $2868.04 $50.00
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.40 $35.00 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 38 42 58.69 $2934.29 $50.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 92 101 111.85 $5592.51 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.97 $24.17 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 0.02 $0.42 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 152 192 751.59 $37579.39 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 3 3 22.00 $1100.00 $50.00
INTR -INTR INTERPRETER 1 3 6.00 $300.00 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 65 67 399.59 $27124.23 $67.88
OCCT -97530HM OT SESSION BY OT ASST 2 2 10.36 $562.60 $54.32
PHY -97110 PT SESSION BY LICENSED PT 95 106 546.58 $37101.99 $67.88
PHY -97110HM PT SESSION BY PT ASST 1 1 5.43 $294.88 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 3 3 2.66 $2.66 $1.00
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 2 2 9.00 $450.00 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 229 262 1134.48 $77008.72 $67.88
SPL -92508 GROUP SPL SESSION PER CHILD 5 5 19.14 $252.69 $13.20
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 330 509 182795.57 $91397.78 $0.50
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 5 5 11.80 $589.76 $50.00
--------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 401 1452 186067.56 $298623.41 $1.60
-----------------------------------------------------------------------------------------------------------------------------
Total 1711 186329.56 $312017.19 $1.67
-----------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 435