Summary Report for FSPSAs Initiated During the Report Period Center: 03
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: 10-01-12 and 12-31-12 Date of Report: 02-16-13 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
Service Coordination, Class # 01
SCONLY-SCONLY SERVICE COORDINATION ONLY 46 46 106.133332 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 46 46 106.133332 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 31 38 15.288888 $741.5100 $48.5000
AUDE -AUDE UNSPECIFIED AUDE SERVICES 4 4 6.950000 $417.0000 $60.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 0.027778 $2.0900 $75.0600
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.008333 $0.6200 $74.7000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 48 48 0.461104 $34.5300 $74.8900
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 14 14 0.133331 $9.9800 $74.8700
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1 1 0.122222 $5.9300 $48.4900
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 1 1 0.200000 $9.7000 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 0.272222 $13.2000 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 2 2 0.344445 $16.7100 $48.5100
VISD -VISD VISION EVALUATION DIAGNOSTIC 1 1 0.161111 $16.1100 $99.9900
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Subtotal (Total Children Is Unduplicated) 104 114 23.969434 $1267.3700 $52.8700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 8 10 4.938889 $7408.3500 $1500.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 255 324 2.132008 $106.9200 $50.1500
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 9 9 0.023613 $0.6000 $25.2000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 225 250 488.576191 $24428.8100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 113 132 232.796028 $11639.7800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 88 99 167.807933 $8390.3800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 238 260 459.657935 $22982.8900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 89 97 769.477784 $38473.9000 $50.0000
INTR -INTR INTERPRETER 25 27 246.869842 $12343.5000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 9 10 80.380952 $5456.2600 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 14 16 114.485714 $7771.3000 $67.8800
SENS -FM FM RECEIVER HEARING AID 1 1 0.066667 $110.0600 $1650.8200
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 2 2 0.727778 $363.9000 $500.0200
SENS -V5264 EARMOLD 3 4 2.061111 $37.1000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 23 27 246.885714 $16758.6200 $67.8800
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 392 849 286153.633334 $143076.8200 $0.5000
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Subtotal (Total Children Is Unduplicated) 418 2117 288970.521493 $299349.1400 $1.0400
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Total 2277 289100.624259 $300616.5100 $1.0400
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Number of Children (Unduplicated) With at Least One Authorization 490