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 11 11 7.345237 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 11 11 7.345237 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 2 2 0.324505 $15.7400 $48.5000
AUDE -AUDE UNSPECIFIED AUDE SERVICES 1 1 0.060274 $3.6200 $60.0300
EVAL -EVAL DEVELOPMENTAL EVALUATION 1 1 0.007534 $0.3800 $49.7700
EXIT -EXIT EXIT ASSESSMENT 36 37 17.137975 $856.8900 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 10 10 0.071762 $5.3900 $75.0400
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 4 4 0.033256 $2.4900 $74.8700
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 12 12 0.093908 $5.2200 $55.5500
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 4 4 0.033180 $2.4900 $75.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 0.288889 $14.0100 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 2 2 0.344444 $16.7000 $48.4900
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Subtotal (Total Children Is Unduplicated) 61 74 18.395727 $922.9200 $50.1700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 3.666667 $18333.5000 $5000.0500
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 36 39 0.159177 $7.9400 $49.8800
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 34 35 54.778933 $2738.9500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 6 6 7.038095 $351.9000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 44 48 68.062266 $3403.1300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 17 18 97.338096 $4866.9100 $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 1 1 12.428571 $621.4300 $50.0000
INTR -INTR INTERPRETER 7 9 4.864916 $243.2500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 3 3 18.285715 $1241.2300 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 3 3 13.004761 $882.7700 $67.8800
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 9 9 67.695240 $4595.1500 $67.8800
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Subtotal (Total Children Is Unduplicated) 122 226 419.834902 $40910.8400 $97.4500
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Total 311 445.575866 $41833.7600 $93.8900
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Number of Children (Unduplicated) With at Least One Authorization 176