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: 04/01/09 and 06/30/09 Date of Report: 08-25-09 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 2 2 4.00 $0.00 $0.00
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Subtotal (Total Children Is Unduplicated) 2 2 4.00 $0.00 $0.00
Screening, Eval, and Assessment, Class # 02
AUDE -AUDE UNSPECIFIED AUDE SERVICES 1 1 1.00 $60.00 $60.00
EXIT -EXIT TRANSITION ASSESSMENT 27 27 54.00 $2700.00 $50.00
IPDEF -IPDEF_NM F/U PSYCH & DEV EVAL BY NON-MED PRO 1 2 2.00 $111.00 $55.50
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 1.50 $112.50 $75.00
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 1.00 $75.00 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 3 3 3.53 $196.10 $55.50
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 89 89 160.00 $12000.00 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 52 52 84.50 $6337.50 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 13 13 24.00 $1800.00 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 91 91 157.03 $8715.35 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 31 32 60.50 $4537.50 $75.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 3 3 3.00 $145.50 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 4 4 4.00 $194.00 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 6 6 6.00 $291.00 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 11 11 22.00 $1067.00 $48.50
VISD -VISD VISION EVALUATION DIAGNOSTIC 3 3 10.97 $1096.67 $100.00
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Subtotal (Total Children Is Unduplicated) 177 339 595.03 $39439.12 $66.28
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 3.00 $4500.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 3 3 3.00 $150.00 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 11 12 11.50 $575.00 $50.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 13 15 17.70 $885.00 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 2 2 5.57 $139.29 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 13 14 13.65 $682.50 $50.00
CONOP -CONOP CONSULT, OT, PHONE 4 4 4.00 $100.00 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 24 26 23.97 $1198.33 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 2 2 4.75 $118.75 $25.00
ECE -ECE EARLY CHILDHOOD EDUCATION 7 7 1007.86 $12598.21 $12.50
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 106 110 666.37 $33318.32 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 1 1 5.14 $257.15 $50.00
INTR -INTR INTERPRETER 1 1 3.00 $150.00 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 36 36 183.26 $12439.81 $67.88
OCCT -97530HM OT SESSION BY OT ASST 13 13 53.00 $2878.69 $54.32
PHY -97110 PT SESSION BY LICENSED PT 24 25 162.56 $11034.70 $67.88
PHY -97110HM PT SESSION BY PT ASST 1 1 5.86 $318.16 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 3 3 3.00 $3.00 $1.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 47 51 349.50 $23724.03 $67.88
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 16.14 $213.02 $13.20
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 3 3 7.57 $378.57 $50.00
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Subtotal (Total Children Is Unduplicated) 192 335 2550.39 $105662.53 $41.43
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Total 676 3149.42 $145101.65 $46.07
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Number of Children (Unduplicated) With at Least One Authorization 257