Summary Report for FSPSAs Ending During the Report Period Center: 02
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: 07/01/09 and 09/30/09 Date of Report: 11-16-09 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
Screening, Eval, and Assessment, Class # 02
AUDE -AUDE UNSPECIFIED AUDE SERVICES 4 4 4.00 $240.00 $60.00
EXIT -EXIT TRANSITION ASSESSMENT 30 30 60.00 $3000.00 $50.00
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 3.00 $225.00 $75.00
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 1.00 $75.00 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 4 5 8.00 $444.00 $55.50
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 81 81 145.77 $10932.51 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 39 39 66.00 $4950.00 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 4 4 6.50 $487.50 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 63 63 114.13 $6334.40 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 30 30 58.00 $4350.00 $75.00
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 4 4 4.00 $194.00 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 6 6 9.57 $464.21 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 7 7 7.00 $339.50 $48.50
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Subtotal (Total Children Is Unduplicated) 153 277 487.97 $32084.63 $65.75
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.00 $3000.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 3 3 3.00 $150.00 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 13 13 15.25 $762.50 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 1 1 1.00 $25.00 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 12 13 14.07 $703.34 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 1 1 0.09 $2.30 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 6 6 4.73 $236.67 $50.00
CONOP -CONOP CONSULT, OT, PHONE 2 2 1.70 $42.50 $25.00
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.00 $25.00 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 13 14 16.33 $816.67 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 2 2 5.46 $136.49 $25.00
ECE -ECE EARLY CHILDHOOD EDUCATION 3 3 223.57 $2794.64 $12.50
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 88 96 655.50 $32775.05 $50.00
INTR -INTR INTERPRETER 1 1 3.00 $150.00 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 29 29 154.56 $10491.35 $67.88
OCCT -97530HM OT SESSION BY OT ASST 11 11 91.89 $4991.49 $54.32
PHY -97110 PT SESSION BY LICENSED PT 25 25 213.41 $14486.33 $67.88
PHY -97110HM PT SESSION BY PT ASST 4 4 22.14 $1202.80 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 9 10 19.00 $19.00 $1.00
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 1 1 4.00 $200.00 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 62 65 487.71 $33106.08 $67.88
SPL -92508 GROUP SPL SESSION PER CHILD 6 7 26.86 $354.58 $13.20
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 2 2 1.36 $67.86 $50.00
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Subtotal (Total Children Is Unduplicated) 189 312 1967.64 $106539.62 $54.15
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Total 589 2455.61 $138624.25 $56.45
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Number of Children (Unduplicated) With at Least One Authorization 299