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 4 4 0.752663 $36.5000 $48.5000
EVAL -EVAL DEVELOPMENTAL EVALUATION 1 1 0.007534 $0.3800 $49.7700
EXIT -EXIT EXIT ASSESSMENT 52 52 8.474734 $423.7300 $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 0.027778 $1.3500 $48.5400
SPCH -92506 SPEECH EVAL BY LICENSED SLP 2 2 0.344444 $16.7000 $48.4900
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Subtotal (Total Children Is Unduplicated) 79 90 9.839259 $494.2400 $50.2300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 4.505555 $22527.5000 $4999.9400
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 37 41 2.725844 $136.2800 $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 5 6 4.566666 $228.3300 $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
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 4 4 3.145206 $78.6300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 24 24 93.420638 $4671.0300 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 1 1 0.428571 $21.4300 $50.0000
INTR -INTR INTERPRETER 6 10 6.279203 $313.9700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 6.107143 $414.5600 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 2 2 1.459524 $99.0800 $67.8800
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 6 7 34.794444 $2361.8400 $67.8800
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Subtotal (Total Children Is Unduplicated) 138 264 406.657547 $43075.4100 $105.9300
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Total 365 430.548393 $43569.6500 $101.2000
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Number of Children (Unduplicated) With at Least One Authorization 196