Summary Report for FSPSAs Ending During the Report Period Center: 03
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: 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 2 2 2.000000 $97.0000 $48.5000
AUDE -AUDE UNSPECIFIED AUDE SERVICES 34 34 34.000000 $2040.0000 $60.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.000000 $115.0000 $115.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 84 84 150.500000 $8352.7500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 5 5 8.500000 $637.5000 $75.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 35 36 37.000000 $1794.5000 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 31 31 30.100000 $1459.8500 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 36 36 36.000000 $1746.0000 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 29 29 29.000000 $1406.5000 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 99 101 101.000000 $4898.5000 $48.5000
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Subtotal (Total Children Is Unduplicated) 304 360 431.100000 $22658.6000 $52.5600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 12 13 27.000000 $40500.0000 $1500.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 222 268 248.642857 $12432.1500 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 3 3 1.750000 $43.7500 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 193 210 352.404761 $17620.2400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 102 108 186.669844 $9333.5000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 104 116 187.046030 $9352.3000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 230 250 378.712698 $18935.6400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 198 217 1380.050794 $69002.5500 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 1 1 9.428571 $471.4300 $50.0000
INTR -INTR INTERPRETER 24 42 293.042857 $14652.1500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 61 71 392.423811 $26637.7100 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 69 77 505.044442 $34282.4200 $67.8800
SCONLY-SCONLY SERVICE COORDINATION ONLY 53 55 55.000000 $55.0000 $1.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 118 135 891.761908 $60532.7900 $67.8800
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 77 102 41983.809527 $20991.9100 $0.5000
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Subtotal (Total Children Is Unduplicated) 488 1668 46892.788100 $334843.5200 $7.1400
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Total 2028 47323.888100 $357502.1200 $7.5500
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Number of Children (Unduplicated) With at Least One Authorization 590