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: 04/01/10 and 06/30/10 Date of Report: 08-17-10 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
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.68 $5.99 $8.83
AUDE -AUDE UNSPECIFIED AUDE SERVICES 1 1 1.00 $60.00 $60.00
EXIT -EXIT TRANSITION ASSESSMENT 10 10 9.57 $478.57 $50.00
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 49 58 62.29 $3020.86 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 19 23 23.00 $1115.50 $48.50
SCREEN-T1023 INTERDISCIPLINARY SCREENING 30 30 30.00 $1500.00 $50.00
SPCH -92506 SPEECH EVAL BY LICENSED SLP 97 120 128.86 $6249.57 $48.50
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Subtotal (Total Children Is Unduplicated) 197 243 255.39 $12430.48 $48.67
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 3.00 $4500.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 3 3 12.17 $608.34 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 1 1.00 $50.00 $50.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 102 115 163.75 $8187.48 $50.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 68 72 106.35 $5317.48 $50.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 42 44 63.76 $3187.78 $50.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 110 125 170.73 $8536.64 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 1 1 3.03 $75.83 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 5 5 30.14 $753.57 $25.00
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 2.07 $103.57 $50.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 160 191 876.44 $43821.83 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 2 2 19.57 $978.57 $50.00
INTR -INTR INTERPRETER 2 3 4.34 $217.23 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 86 99 606.16 $41146.11 $67.88
OCCT -97530HM OT SESSION BY OT ASST 6 6 44.24 $2403.01 $54.32
PHY -97110 PT SESSION BY LICENSED PT 88 95 497.42 $33765.19 $67.88
PHY -97110HM PT SESSION BY PT ASST 4 4 8.45 $459.13 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 12 13 6.49 $6.49 $1.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 1 1 1.00 $500.00 $500.00
SENS -V5264 EARMOLD 1 1 1.36 $25.38 $18.72
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 2 2 2.00 $100.00 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 281 335 1526.59 $103624.64 $67.88
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 2.86 $37.71 $13.20
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 330 533 195654.48 $97827.24 $0.50
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 9 9 8.41 $420.47 $50.00
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Subtotal (Total Children Is Unduplicated) 429 1665 199815.80 $356653.68 $1.78
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Total 1908 200071.19 $369084.16 $1.84
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Number of Children (Unduplicated) With at Least One Authorization 490