Summary Report for FSPSAs Initiated During the Report Period Center: 02
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: 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 14.051587 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 11 11 14.051587 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 9 9 1.518797 $73.6600 $48.5000
AUDE -AUDE UNSPECIFIED AUDE SERVICES 2 2 0.126332 $7.5800 $59.9800
EVAL -EVAL DEVELOPMENTAL EVALUATION 1 1 0.007534 $0.3800 $49.7700
EXIT -EXIT EXIT ASSESSMENT 54 54 8.819178 $440.9500 $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
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1 1 0.153425 $7.4400 $48.4900
PSTH -97001 EVAL BY LICENSED PT, INITIAL 7 7 0.493302 $23.9300 $48.5100
SPCH -92506 SPEECH EVAL BY LICENSED SLP 4 4 0.700000 $33.9500 $48.5000
VISF -VISF VISION EVALUATION FUNCTIONAL 1 1 0.444444 $22.2200 $50.0000
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Subtotal (Total Children Is Unduplicated) 217 368 14.260518 $750.5400 $52.6300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 9 9 15.299315 $76496.5000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 40 46 2.740229 $136.9900 $49.9900
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 1 1 0.004167 $0.1100 $25.2000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 50 54 79.386539 $3969.3200 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 1 1 0.033333 $0.8300 $24.9800
CONOF -CONOF CONSULT, OT, FACE TO FACE 48 49 72.702738 $3635.1300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 6 7 6.366666 $318.3300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 55 58 87.597976 $4379.8900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 9.500000 $237.5000 $25.0000
ECE -ECE EARLY CHILDHOOD EDUCATION 8 8 532.428572 $6655.3600 $12.5000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 10 13 224.573779 $5614.3400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 149 152 905.896835 $45294.8100 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 2 2 6.071428 $303.5800 $50.0000
INTR -INTR INTERPRETER 6 10 6.279203 $313.9700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 45 47 266.700002 $18103.5800 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 1 1 2.857143 $155.2000 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 46 47 277.745242 $18853.3600 $67.8800
PHY -97110HM PT SESSION BY PT ASST 1 1 3.785714 $205.6400 $54.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 82 86 509.942073 $34614.8300 $67.8800
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 1 1 1.100000 $55.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 274 595 3011.010954 $219344.2400 $72.8500
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Total 974 3039.323059 $220094.7800 $72.4200
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Number of Children (Unduplicated) With at Least One Authorization 358