Summary Report for FSPSAs Initiated During the Report Period Center: 01
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: 10-01-11 and 12-31-11 Date of Report: 02-15-12 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 13 13 14.000000 $679.0000 $48.5000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 3 3 6.000000 $750.0000 $125.0000
EXIT -EXIT TRANSITION ASSESSMENT 123 125 245.750000 $12287.5000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 2 4.000000 $300.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 15 15 30.000000 $2250.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 8 8 16.000000 $1200.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 14 14 28.000000 $1554.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 28 30 60.000000 $4500.0000 $75.0000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 1 1 1.000000 $48.5000 $48.5000
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Subtotal (Total Children Is Unduplicated) 175 214 410.750000 $23980.0000 $58.3800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 13.428571 $20142.9000 $1500.0000
AUD -HA_FUP AUDIOLOGY SERVICES 1 1 1.000000 $50.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 110 124 193.288094 $9664.4100 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 6 6 3.000000 $75.0000 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 41 44 98.357142 $4917.8600 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 12 12 15.914286 $397.8600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 7 9 15.538096 $776.9100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 23 24 42.466666 $2123.3300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 7 7 15.780952 $394.5200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 42 45 109.590477 $5479.5300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 13 13 21.052380 $526.3100 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 11.714286 $585.7200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 35 36 189.885720 $9494.2900 $50.0000
INTR -INTR INTERPRETER 63 105 318.864285 $15943.2100 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 13.142857 $892.1400 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 4 4 43.142857 $2928.5300 $67.8800
SCONLY-SCONLY SERVICE COORDINATION ONLY 39 39 42.304762 $42.3000 $1.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 7 8 89.428571 $6070.4100 $67.8800
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 755 1088 5486.755590 $2743.3800 $0.5000
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Subtotal (Total Children Is Unduplicated) 807 1569 6724.655592 $83248.6000 $12.3800
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Total 1783 7135.405592 $107228.6000 $15.0300
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Number of Children (Unduplicated) With at Least One Authorization 870