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: 10-01-12 and 12-31-12 Date of Report: 02-16-13 Page: 1
Child has a MEDICAID # Filter: Y
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
Service Coordination, Class # 01
SCONLY-SCONLY SERVICE COORDINATION ONLY 41 41 93.644445 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 41 41 93.644445 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 32 34 7.633335 $370.2200 $48.5000
AUDE -AUDE UNSPECIFIED AUDE SERVICES 4 4 0.850000 $51.0000 $60.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 0.022222 $1.6700 $74.9300
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 22 22 0.216663 $16.2200 $74.8700
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 5 5 0.044444 $3.3300 $74.9300
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 2 2 0.166666 $8.0800 $48.4800
PSTH -97001 EVAL BY LICENSED PT, INITIAL 2 2 0.355555 $17.2400 $48.4900
SPCH -92506 SPEECH EVAL BY LICENSED SLP 2 2 0.116666 $5.6600 $48.4700
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Subtotal (Total Children Is Unduplicated) 69 73 9.405551 $473.4200 $50.3300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 12 14 5.333334 $8000.1000 $1500.0200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 158 193 0.983376 $49.3800 $50.2100
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 5 5 0.012501 $0.3200 $25.2000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 163 184 276.198417 $13809.9500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 52 57 81.277780 $4063.9000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 68 71 96.369841 $4818.4900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 177 196 272.877782 $13643.9100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 17 19 115.228571 $5761.4400 $50.0000
INTR -INTR INTERPRETER 27 30 176.800001 $8840.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 5 6 31.152381 $2114.6200 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 11 13 49.428569 $3355.2100 $67.8800
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 12 13 74.571429 $5061.9100 $67.8800
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 262 591 145617.626990 $72808.8100 $0.5000
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Subtotal (Total Children Is Unduplicated) 294 1392 146797.860972 $142328.0400 $0.9700
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Total 1506 146900.910968 $142801.4600 $0.9700
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Number of Children (Unduplicated) With at Least One Authorization 354