Summary Report for FSPSAs Initiated During the Report Period Center: 54
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 5 5 10.260318 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 5 10.260318 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 4 4 2.638889 $127.9900 $48.5000
EXIT -EXIT EXIT ASSESSMENT 20 23 28.804566 $1440.2300 $50.0000
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Subtotal (Total Children Is Unduplicated) 24 27 31.443455 $1568.2100 $49.8700
EI Services, Class # 03
AUD -HA_FUP AUDIOLOGY SERVICES 2 2 0.583257 $29.1700 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 3 4 15.649208 $782.4700 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 2 2 1.148413 $28.7100 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 45 203 221.220827 $11061.0100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 12 12 32.663493 $1633.1800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 3.000000 $75.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 14 15 27.655555 $1382.7800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 16 16 23.749207 $1187.4600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 4.071429 $101.7900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 4 4 30.052382 $1502.6200 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 1 1 0.600000 $30.0000 $50.0000
INTR -INTR INTERPRETER 3 3 24.142857 $1207.1500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 13.142857 $892.1400 $67.8800
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4 4 40.785714 $2768.5300 $67.8800
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 129 323 102215.129448 $51107.5700 $0.5000
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Subtotal (Total Children Is Unduplicated) 137 593 102653.594647 $73789.5600 $0.7200
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Total 625 102695.298420 $75357.7700 $0.7300
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Number of Children (Unduplicated) With at Least One Authorization 155