Summary Report for FSPSAs Ending During the Report Period Center: 06
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: 01/01/10 and 03/31/10 Date of Report: 05-17-10 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
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 1.00 $48.50 $48.50
AUDE -V5010 ASSESSMENT FOR HEARING AID 12 12 12.00 $561.60 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 12 12 12.00 $1435.20 $119.60
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 1.00 $48.50 $48.50
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Subtotal (Total Children Is Unduplicated) 14 26 26.00 $2093.80 $80.53
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 5 5.00 $7500.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 27 29 49.92 $2495.87 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 15 17 18.25 $912.50 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 5 5 2.50 $62.50 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 4 5 7.53 $376.67 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 3 3 2.51 $62.71 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 27 32 43.84 $2191.91 $50.00
CONOP -CONOP CONSULT, OT, PHONE 3 3 1.36 $33.96 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 19 21 26.10 $1304.76 $50.00
CONPP -CONPP CONSULT, PT, PHONE 3 3 2.21 $55.21 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 11 12 19.05 $952.62 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 4 4 2.62 $65.42 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 58 72 809.71 $20242.86 $25.00
EIIF -COUN UNSPECIFIED COUNSELING 1 1 2.86 $142.86 $50.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 229 253 1428.97 $71448.57 $50.00
INTR -INTR INTERPRETER 42 45 153.20 $7660.24 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 103 121 390.02 $26474.28 $67.88
OCCT -97530HM OT SESSION BY OT ASST 6 6 28.79 $1563.64 $54.32
PHY -97110 PT SESSION BY LICENSED PT 195 220 806.38 $54736.79 $67.88
PHY -97110HM PT SESSION BY PT ASST 6 8 27.93 $1517.07 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 36 36 37.43 $37.43 $1.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 12 12 12.00 $6000.00 $500.00
SENS -V5264 EARMOLD 12 12 4.17 $78.00 $18.72
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 494 581 2326.92 $157951.53 $67.88
SPL -92508 GROUP SPL SESSION PER CHILD 15 18 100.86 $1331.31 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 1 1 1.00 $100.00 $100.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 1 1 8.29 $4.14 $0.50
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 3 3 45.14 $2257.15 $50.00
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Subtotal (Total Children Is Unduplicated) 859 1529 6364.54 $367559.97 $57.75
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Total 1555 6390.54 $369653.77 $57.84
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Number of Children (Unduplicated) With at Least One Authorization 859