Summary Report for FSPSAs Ending During the Report Period Center: 02
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: 01-01-13 and 03-31-13 Date of Report: 05-17-13 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 12 12 7.845237 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 12 12 7.845237 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 5 5 1.163395 $56.4300 $48.5000
AUDE -AUDE UNSPECIFIED AUDE SERVICES 2 2 0.243607 $14.6200 $60.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 1 1 0.007534 $0.3800 $49.7700
EXIT -EXIT EXIT ASSESSMENT 36 37 17.137975 $856.8900 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 5 5 0.047145 $3.5300 $74.9300
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 3 3 0.024923 $1.8700 $74.9300
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 0.016590 $1.2500 $75.0500
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 3 3 0.022069 $1.2300 $55.5700
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 116 116 0.858956 $64.4300 $75.0100
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 36 36 0.210537 $15.8000 $75.0200
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 72 72 0.461284 $25.6300 $55.5700
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 52 52 0.356002 $26.7100 $75.0200
PSTH -97001 EVAL BY LICENSED PT, INITIAL 6 6 3.227778 $156.5500 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 5 5 1.594444 $77.3300 $48.5000
VISF -VISF VISION EVALUATION FUNCTIONAL 1 1 0.055556 $2.7800 $50.0400
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Subtotal (Total Children Is Unduplicated) 197 346 25.427795 $1305.4100 $51.3400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 8 8 10.800000 $54000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 39 44 0.173562 $8.6600 $49.8700
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 1 1 0.004167 $0.1100 $25.2000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 45 49 66.941632 $3347.1000 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 1 1 0.033333 $0.8300 $24.9800
CONOF -CONOF CONSULT, OT, FACE TO FACE 35 36 55.845600 $2792.2900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 7 7 8.238095 $411.9000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 44 48 68.062266 $3403.1300 $50.0000
ECE -ECE EARLY CHILDHOOD EDUCATION 9 9 840.428571 $10505.3600 $12.5000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 7 7 156.428571 $3910.7100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 130 139 794.290475 $39714.5400 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 1 1 5.533333 $276.6700 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 2 2 13.161904 $658.1000 $50.0000
INTR -INTR INTERPRETER 7 9 4.864916 $243.2500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 56 61 317.276190 $21536.6900 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 46 47 226.033327 $15343.1300 $67.8800
PHY -97110HM PT SESSION BY PT ASST 2 2 4.861904 $264.1000 $54.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 62 67 430.619047 $29230.4200 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 4 4 14.500000 $191.4000 $13.2000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 1 1 8.142857 $407.1500 $50.0000
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Subtotal (Total Children Is Unduplicated) 244 543 3026.239750 $186245.5000 $61.5400
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Total 901 3059.512782 $187550.9000 $61.3000
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Number of Children (Unduplicated) With at Least One Authorization 401